Provider Demographics
NPI:1144225236
Name:BOYD, RAE (APRN)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:1400 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4127
Practice Address - Country:US
Practice Address - Phone:360-428-6434
Practice Address - Fax:360-848-4233
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15481363LF0000X
WAAP 30007138363LF0000X
WAAP30007138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30007138OtherNURSE PRACTITIONER
CA15481OtherFURNISHING
CA15481OtherNURSE PRACTITIONER
WARN00161554OtherREGISTERED NURSE
CA65825OtherPUBLIC HEALTH NURSE
2004004681OtherANCC APRN, BC
WA288910OtherLABOR & INDUSTRIES
WA288910OtherLABOR & INDUSTRIES
MB1325972OtherDEA
WARN00161554OtherREGISTERED NURSE
Q47853Medicare UPIN