Provider Demographics
NPI:1013508027
Name:BOYD, BILLY
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:BOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 MENDENHALL PARK PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-5906
Mailing Address - Country:US
Mailing Address - Phone:901-617-6248
Mailing Address - Fax:
Practice Address - Street 1:5275 MENDENHALL PARK PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-5906
Practice Address - Country:US
Practice Address - Phone:901-617-6248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No171WH0202XOther Service ProvidersContractorHome Modifications
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ041329Medicaid