Healthcare Provider Details

I. General information

NPI: 1023929809
Provider Name (Legal Business Name): DOMONIC BOYD NRAEMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7326 HIGHWAY 488
CARTHAGE MS
39051-9485
US

IV. Provider business mailing address

7326 HIGHWAY 488
CARTHAGE MS
39051-9485
US

V. Phone/Fax

Practice location:
  • Phone: 601-287-0936
  • Fax: 601-287-0936
Mailing address:
  • Phone: 601-287-0936
  • Fax: 601-287-0936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number1021830
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: