Provider Demographics
NPI:1336396415
Name:BYRD, RONALD JOE (FNP)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JOE
Last Name:BYRD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1300 S MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5662
Mailing Address - Country:US
Mailing Address - Phone:928-536-7519
Mailing Address - Fax:928-536-7305
Practice Address - Street 1:590 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5228
Practice Address - Country:US
Practice Address - Phone:928-536-7519
Practice Address - Fax:928-536-7305
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP3061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1629236716Medicaid
AZ1780614008Medicaid
AZ1871523191Medicaid
AZ1295993376Medicaid