Provider Demographics
NPI:1043785314
Name:BOYD, REBECCA LOU (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LOU
Last Name:BOYD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 STATE ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PINE
Mailing Address - State:TN
Mailing Address - Zip Code:37890-3175
Mailing Address - Country:US
Mailing Address - Phone:865-674-6603
Mailing Address - Fax:
Practice Address - Street 1:1403 STATE ST
Practice Address - Street 2:
Practice Address - City:WHITE PINE
Practice Address - State:TN
Practice Address - Zip Code:37890-3175
Practice Address - Country:US
Practice Address - Phone:865-674-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily