Provider Demographics
NPI:1710983515
Name:BOYD-LONG, LESLIE A (CRNA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:BOYD-LONG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3014 104TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-6088
Practice Address - Country:US
Practice Address - Phone:806-745-1656
Practice Address - Fax:806-743-2984
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135111367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85130UOtherBLUE CROSS & BLUE SHIELD
TX85131UOtherHMO BLUE
NM93580584Medicaid
NM93524OtherPRESBYTERIAN COMMERCIAL
NM93524Medicaid
TX85130UOtherBLUE CROSS & BLUE SHIELD
TXS36275Medicare UPIN