Healthcare Provider Details

I. General information

NPI: 1376675868
Provider Name (Legal Business Name): KATHLEEN BOYD RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FOURTH PLAIN BLVD
VANCOUVER WA
98661-3753
US

IV. Provider business mailing address

1312 W 40TH ST
VANCOUVER WA
98660-1524
US

V. Phone/Fax

Practice location:
  • Phone: 360-696-4061
  • Fax: 360-750-5354
Mailing address:
  • Phone: 360-885-3747
  • Fax: 360-885-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: