Provider Demographics
NPI:1255016952
Name:BOYD, TAMMY SUE
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:SUE
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAMMY
Other - Middle Name:SUE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:695 MOUNTAINEER HWY
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-0255
Mailing Address - Country:US
Mailing Address - Phone:304-294-8800
Mailing Address - Fax:
Practice Address - Street 1:695 MOUNTAINEER HWY
Practice Address - Street 2:
Practice Address - City:MULLENS
Practice Address - State:WV
Practice Address - Zip Code:25882-0255
Practice Address - Country:US
Practice Address - Phone:304-294-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant