Provider Demographics
NPI:1710207808
Name:BOYD, SUZETTE NICOLE (APN)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:NICOLE
Last Name:BOYD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 512
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-0512
Mailing Address - Country:US
Mailing Address - Phone:870-946-3637
Mailing Address - Fax:870-946-4410
Practice Address - Street 1:1641 SOUTH WHITEHEAD DRIVE
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:AR
Practice Address - Zip Code:72042-0000
Practice Address - Country:US
Practice Address - Phone:870-946-3637
Practice Address - Fax:870-946-4409
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily