Provider Demographics
NPI:1912530551
Name:BOYD, KESEYA KEMYADA
Entity Type:Individual
Prefix:
First Name:KESEYA
Middle Name:KEMYADA
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-2152
Mailing Address - Country:US
Mailing Address - Phone:817-233-0276
Mailing Address - Fax:
Practice Address - Street 1:13245 FIDDLERS TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5804
Practice Address - Country:US
Practice Address - Phone:817-233-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660875163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health