Provider Demographics
NPI:1720293145
Name:BOYD, BARBARA A (P233404)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:A
Last Name:BOYD
Suffix:
Gender:F
Credentials:P233404
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4920
Mailing Address - Country:US
Mailing Address - Phone:601-422-0655
Mailing Address - Fax:601-422-0655
Practice Address - Street 1:901 S 14TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4920
Practice Address - Country:US
Practice Address - Phone:601-422-0655
Practice Address - Fax:601-422-0655
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP233404164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770245Medicaid