Provider Demographics
NPI:1841278959
Name:BLOYD, DEBORAH LYNN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:BLOYD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S JACKSON ST DEPT OB
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-271-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2517P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50012922OtherPASSPORT-SPECIALTY FOUNDATION LOCATION
KY000000542935OtherANTHEM FOUNDATION
KY50004862OtherPASSPORT SPECIALITY-PSC LOCATION
KY000000351403OtherANTHEM PSC LOCATION
KY50012926OtherPASSPORT-PCP FOUNDATION LOCATION
KY78025178Medicaid
KY000000351403OtherANTHEM PSC LOCATION
KY50012926OtherPASSPORT-PCP FOUNDATION LOCATION