Provider Demographics
NPI:1245594811
Name:BOYD, TRACI LYNN (APRN)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:BOYD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LYNN
Other - Last Name:QUEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:105 STATE HIGHWAY 1947 # A
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-6825
Practice Address - Country:US
Practice Address - Phone:606-475-0152
Practice Address - Fax:606-474-4240
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100209530Medicaid
OH0067537Medicaid
OH0067537Medicaid