Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN080131-AP06450 | LA |
NPI | 1275805020 |
---|---|
Provider Name | Paul Wayne Byrd |
First Address | Bossier City, LA 71111 |
Second Address | Bossier City, LA 71111-2182 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2012 |
Last Update Date | 02/02/2017 |