Healthcare Provider Details

I. General information

NPI: 1972961068
Provider Name (Legal Business Name): ALINE BAYARD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 09/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 B VETERANS BLVD
ACOMA NM
87034
US

IV. Provider business mailing address

6131 S NORCROSS TUCKER RD
NORCROSS GA
30093-5536
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5300
  • Fax: 505-552-5490
Mailing address:
  • Phone: 678-205-1959
  • Fax: 770-552-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN141931
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: