Provider Demographics
NPI:1265936686
Name:BOYD, KENYSHA N (LPN)
Entity type:Individual
Prefix:
First Name:KENYSHA
Middle Name:N
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 1:5350 CAMELOT DR APT 22
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7430
Mailing Address - Country:US
Mailing Address - Phone:813-409-4121
Mailing Address - Fax:
Practice Address - Street 1:621 S ERIE HWY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4315
Practice Address - Country:US
Practice Address - Phone:513-795-7557
Practice Address - Fax:513-737-4603
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139562164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse