Provider Demographics
NPI:1295007128
Name:BOYD, CEDRIC SR (RN, WCC)
Entity Type:Individual
Prefix:PROF
First Name:CEDRIC
Middle Name:
Last Name:BOYD
Suffix:SR
Gender:M
Credentials:RN, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2623
Mailing Address - Street 2:
Mailing Address - City:SOUTH PADRE ISLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78597-2623
Mailing Address - Country:US
Mailing Address - Phone:956-299-1000
Mailing Address - Fax:956-772-0100
Practice Address - Street 1:224 SUNSET DR.
Practice Address - Street 2:
Practice Address - City:SOUTH PADRE ISLAND
Practice Address - State:TX
Practice Address - Zip Code:78597
Practice Address - Country:US
Practice Address - Phone:956-299-1000
Practice Address - Fax:956-772-0100
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729752163W00000X, 163WH0200X, 163WI0500X, 163WP0200X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WW0000XNursing Service ProvidersRegistered NurseWound Care