Healthcare Provider Details

I. General information

NPI: 1689252637
Provider Name (Legal Business Name): KIMBERLY BOYD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5058 BLUE RIDGE BLVD # 101
KANSAS CITY MO
64133-2549
US

IV. Provider business mailing address

5058 BLUE RIDGE BLVD # 101
KANSAS CITY MO
64133-2549
US

V. Phone/Fax

Practice location:
  • Phone: 816-596-1136
  • Fax: 816-569-1623
Mailing address:
  • Phone: 816-596-1136
  • Fax: 816-569-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number14-84124-112
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: