Basic Information
| Provider Information | |||||||||
| NPI: | 1134748411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSMON | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | LOYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 WEATHERWOOD DR | ||||||||
| Address2: | |||||||||
| City: | GREENBRIER | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720588816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5014725907 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2425 PRINCE ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720343701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013276665 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2020 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 125382 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.