Healthcare Provider Details

I. General information

NPI: 1245594811
Provider Name (Legal Business Name): TRACI LYNN BOYD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACI LYNN QUEEN APRN

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 STATE HIGHWAY 1947 # A
GRAYSON KY
41143-6825
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 606-475-0152
  • Fax: 606-474-4240
Mailing address:
  • Phone: 606-408-6200
  • Fax: 606-408-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007378
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: