Provider Demographics
NPI:1346375565
Name:BOYD, NANCY DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:DIANE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:DIANE
Other - Last Name:BUHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:144 BUENA VISTA DR.
Mailing Address - Street 2:P.O. BOX 1754
Mailing Address - City:KERNVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93238
Mailing Address - Country:US
Mailing Address - Phone:760-376-6504
Mailing Address - Fax:760-376-1625
Practice Address - Street 1:144 BUENA VISTA DR.
Practice Address - Street 2:
Practice Address - City:KERNVILLE
Practice Address - State:CA
Practice Address - Zip Code:93238
Practice Address - Country:US
Practice Address - Phone:760-376-6504
Practice Address - Fax:760-376-1625
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA044984208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA449840Medicaid
CA770525788OtherTAX I.D.
CAA449840Medicaid