Provider Demographics
NPI:1932413762
Name:BOYD, BENDAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:BENDAN
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BENDAN
Other - Middle Name:
Other - Last Name:DRIGGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:501 AZALEA DR. SUITE F
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367
Mailing Address - Country:US
Mailing Address - Phone:601-735-3737
Mailing Address - Fax:601-735-3733
Practice Address - Street 1:501 AZALEA DR. SUITE F
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367
Practice Address - Country:US
Practice Address - Phone:601-735-3737
Practice Address - Fax:601-735-3733
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR871239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06608851Medicaid