MEDICARE: MISS JACLYN RENEE BOYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1164306098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JACLYN RENEE BOYD

Provider Business Mailing Address
First Line	:	7535 S TOLEDO AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-6108
Country	:	US
Telephone Number	:	918-581-3468
Fax Number	:

Provider Business Practice Location Address
First Line	:	JACLYNBOYD
Second Line	:	7535 S. TOLEDO AVE
City	:	TULSA
State	:	OK
Zip	:	74136
Country	:	US
Telephone Number	:	918-581-3468
Fax Number	:	918-581-3468

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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