Provider Demographics
NPI:1346293545
Name:BOYD, TERRI L (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:BOYD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7064
Mailing Address - Country:US
Mailing Address - Phone:606-836-7000
Mailing Address - Fax:606-836-3157
Practice Address - Street 1:1201 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7064
Practice Address - Country:US
Practice Address - Phone:606-836-7000
Practice Address - Fax:606-836-3157
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA291363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS98900Medicare UPIN
KY0560503Medicare ID - Type UnspecifiedMEDICARE