Provider Demographics
NPI:1407907074
Name:BOYD, CONNIE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:ARNP
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 3007
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MT
Mailing Address - Zip Code:59935-3007
Mailing Address - Country:US
Mailing Address - Phone:406-295-5752
Mailing Address - Fax:406-295-0314
Practice Address - Street 1:318 KOOTENAI
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MT
Practice Address - Zip Code:59935
Practice Address - Country:US
Practice Address - Phone:406-295-5752
Practice Address - Fax:406-295-0314
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000037183OtherBS
MT500024254OtherPALMETTO GBA
MT4300711Medicaid
MT500024254OtherPALMETTO GBA
MT000037183OtherBS