Healthcare Provider Details

I. General information

NPI: 1992791065
Provider Name (Legal Business Name): CHARISSA YVETTE BOYD MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 MCCORMICK DR SUITE 180
LARGO MD
20774-5326
US

IV. Provider business mailing address

1801 MCCORMICK DR SUITE 180
LARGO MD
20774-5326
US

V. Phone/Fax

Practice location:
  • Phone: 571-239-1243
  • Fax: 877-804-6629
Mailing address:
  • Phone: 571-239-1243
  • Fax: 877-804-6629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR140627
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: