Provider Demographics
NPI:1811927387
Name:BOYD, LORETTA IRENE (LPN)
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:IRENE
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 1:790 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-5723
Mailing Address - Country:US
Mailing Address - Phone:870-367-9732
Mailing Address - Fax:870-460-6133
Practice Address - Street 1:708 HIGHWAY 65 S
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-3004
Practice Address - Country:US
Practice Address - Phone:870-382-4001
Practice Address - Fax:870-382-6094
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL35317164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse