Healthcare Provider Details

I. General information

NPI: 1174304018
Provider Name (Legal Business Name): RACHIDA BOYD CASE MANAGER II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 S LEWIS AVE STE 180
TULSA OK
74136-1077
US

IV. Provider business mailing address

8336 S LEWIS AVE APT 611
TULSA OK
74137-1526
US

V. Phone/Fax

Practice location:
  • Phone: 918-960-7852
  • Fax:
Mailing address:
  • Phone: 918-699-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: