Provider Demographics
NPI:1437644788
Name:BOYD, TIELISIA ANN
Entity Type:Individual
Prefix:
First Name:TIELISIA
Middle Name:ANN
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 E SKELLY DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-3400
Mailing Address - Country:US
Mailing Address - Phone:918-301-0210
Mailing Address - Fax:918-217-1325
Practice Address - Street 1:8906 E SKELLY DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-3400
Practice Address - Country:US
Practice Address - Phone:918-301-0210
Practice Address - Fax:918-217-1325
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37V881621299374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide