Provider Demographics
NPI:1679667471
Name:BOYD, LORIE LYNETTE (FNP)
Entity Type:Individual
Prefix:MS
First Name:LORIE
Middle Name:LYNETTE
Last Name:BOYD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HOLLY HALL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4124
Mailing Address - Country:US
Mailing Address - Phone:713-566-6412
Mailing Address - Fax:713-566-6519
Practice Address - Street 1:602 GIRARD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-6218
Practice Address - Country:US
Practice Address - Phone:832-615-1219
Practice Address - Fax:713-237-1715
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161228504Medicaid
P94060Medicare UPIN
TX8E0151Medicare ID - Type Unspecified
TX161228504Medicaid