Provider Demographics
NPI:1982977559
Name:BOYD, KAREY MICHELLE
Entity Type:Individual
Prefix:
First Name:KAREY
Middle Name:MICHELLE
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 1:16235 W GREGORY TER
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-0822
Mailing Address - Country:US
Mailing Address - Phone:405-821-5442
Mailing Address - Fax:
Practice Address - Street 1:16235 W GREGORY TER
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-0822
Practice Address - Country:US
Practice Address - Phone:405-821-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator