Provider Demographics
NPI:1487208161
Name:BOYD, TAMMY RAE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:RAE
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 1:501 FREDONIA ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3330
Mailing Address - Country:US
Mailing Address - Phone:918-683-0124
Mailing Address - Fax:
Practice Address - Street 1:501 FREDONIA ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3330
Practice Address - Country:US
Practice Address - Phone:918-683-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator