Provider Demographics
NPI:1326566928
Name:BOYD, LEAH RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:RAE
Last Name:BOYD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:RAE
Other - Last Name:TALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:400 WARREN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1467
Mailing Address - Country:US
Mailing Address - Phone:360-377-3776
Mailing Address - Fax:
Practice Address - Street 1:400 WARREN AVE STE 200
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1467
Practice Address - Country:US
Practice Address - Phone:360-377-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-03
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
WA60908255363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program