Provider Demographics
NPI:1609474592
Name:BOYD, GLENDA ANN (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:ANN
Last Name:BOYD
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 GLENWOOD ST STE 500
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-4933
Mailing Address - Country:US
Mailing Address - Phone:254-897-2202
Mailing Address - Fax:254-897-1638
Practice Address - Street 1:2800 VILLAGE RD STE 108
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-4194
Practice Address - Country:US
Practice Address - Phone:817-573-0444
Practice Address - Fax:866-288-8834
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016275363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care