Provider Demographics
NPI:1902410186
Name:BOYD, KATIE ELISE (PNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELISE
Last Name:BOYD
Suffix:
Gender:F
Credentials:PNP-BC
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Mailing Address - Street 1:251 SALINA MEADOWS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:725 IRVING AVE STE 504
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1683
Practice Address - Country:US
Practice Address - Phone:315-464-8444
Practice Address - Fax:315-464-8445
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY383184363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics