Healthcare Provider Details

I. General information

NPI: 1518144419
Provider Name (Legal Business Name): BOYD INTELLECTUAL PROPERTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 WOOD LN
SODDY DAISY TN
37379-3159
US

IV. Provider business mailing address

9191 WOOD LN
SODDY DAISY TN
37379-3159
US

V. Phone/Fax

Practice location:
  • Phone: 423-843-1331
  • Fax:
Mailing address:
  • Phone: 423-843-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: J. LUCY BOYD
Title or Position: PRESIDENT
Credential:
Phone: 423-843-1331