Provider Demographics
NPI:1467036343
Name:BOYD, JALISA LARAY (RN)
Entity Type:Individual
Prefix:
First Name:JALISA
Middle Name:LARAY
Last Name:BOYD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 SUNDANCE CT
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-7605
Mailing Address - Country:US
Mailing Address - Phone:972-948-0095
Mailing Address - Fax:
Practice Address - Street 1:781 SUNDANCE CT
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-7605
Practice Address - Country:US
Practice Address - Phone:972-948-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660939163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator