Provider Demographics
NPI:1992396063
Name:BOYD, BRANDY (LPN)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 YORKLAND RD A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232
Mailing Address - Country:US
Mailing Address - Phone:614-707-2352
Mailing Address - Fax:
Practice Address - Street 1:1378 YORKLAND RD A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232
Practice Address - Country:US
Practice Address - Phone:614-707-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.176316.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse