Provider Demographics
NPI:1679688584
Name:BOYD, LORA A (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:A
Last Name:BOYD
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:A
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUDIOLOGIST
Mailing Address - Street 1:4300 ROGERS AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3152
Mailing Address - Country:US
Mailing Address - Phone:479-785-3277
Mailing Address - Fax:479-785-3278
Practice Address - Street 1:4300 ROGERS AVE STE 15
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3152
Practice Address - Country:US
Practice Address - Phone:479-785-3277
Practice Address - Fax:479-785-3278
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA195231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136113720Medicaid