Healthcare Provider Details

I. General information

NPI: 1801336268
Provider Name (Legal Business Name): KHARISMA BOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9219 SIBLEY HOLE RD
LITTLE ROCK AR
72209
US

IV. Provider business mailing address

118 N 2ND ST STE 200
SAINT CHARLES MO
63301-2894
US

V. Phone/Fax

Practice location:
  • Phone: 501-455-4600
  • Fax: 501-455-4601
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-946-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: