Provider Demographics
NPI:1437319423
Name:BOYD, KATHERINE LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LESLIE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MD
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 873010
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687-3010
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:360-604-1719
Practice Address - Street 1:501 SE 172ND AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-9542
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1719
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254341207N00000X
WAMD60546990207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherMULTIPLAN
VA-005OtherTRICARE/CHAMPUS
VA499831OtherANTHEM BC/BS
VAPAROtherAETNA
VAPAROtherVIRGINIA HEALTH NETWORK
VA1437319423OtherVIRGINIA PREMIER HEALTH PLAN
NC1437319423Medicaid
VA10114693OtherOPTIMA HEALTH
VA1437319423OtherCOVENTRY NETWORK
VA1437319423OtherUNITED HEALTHCARE
VA1437319423OtherCIGNA
VA1437319423Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL
NC1437319423Medicaid
VAVVA783AMedicare PIN