Provider Demographics
NPI:1053136085
Name:OWENS, CARYN DIANE
Entity type:Individual
Prefix:MS
First Name:CARYN
Middle Name:DIANE
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4010
Mailing Address - Country:US
Mailing Address - Phone:870-713-0643
Mailing Address - Fax:501-862-5412
Practice Address - Street 1:910 CHAMPAGNOLLE RD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5013
Practice Address - Country:US
Practice Address - Phone:870-862-2230
Practice Address - Fax:870-862-5412
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services