Healthcare Provider Details

I. General information

NPI: 1184738924
Provider Name (Legal Business Name): RICHARD A BOYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MEDICAL DR
ASH GROVE MO
65604-1005
US

IV. Provider business mailing address

PO BOX 939
BOLIVAR MO
65613-0939
US

V. Phone/Fax

Practice location:
  • Phone: 417-751-2100
  • Fax:
Mailing address:
  • Phone: 417-328-6342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01265
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: