Provider Demographics
NPI:1063659910
Name:BYRD, JAMES R (PA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:BYRD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 HIGHWAY 105 EXT STE 201
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5531
Mailing Address - Country:US
Mailing Address - Phone:828-262-1800
Mailing Address - Fax:828-262-5777
Practice Address - Street 1:178 HIGHWAY 105 EXT STE 201
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5531
Practice Address - Country:US
Practice Address - Phone:828-262-1800
Practice Address - Fax:828-262-5777
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02127363AM0700X
NC0010-01217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical