Provider Demographics
NPI:1508696790
Name:BOYD, LECIA SUE-ANNE (PHMNP-BC)
Entity type:Individual
Prefix:
First Name:LECIA
Middle Name:SUE-ANNE
Last Name:BOYD
Suffix:
Gender:F
Credentials:PHMNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 N SOLSTICE LN
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2867
Mailing Address - Country:US
Mailing Address - Phone:503-550-6332
Mailing Address - Fax:
Practice Address - Street 1:3222 N SOLSTICE LN
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2867
Practice Address - Country:US
Practice Address - Phone:503-550-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10029134363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health