Healthcare Provider Details

I. General information

NPI: 1730172354
Provider Name (Legal Business Name): JENNIFER A BOYD PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER A STURR PA C

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 MALL RD
OAK HILL WV
25901-6216
US

IV. Provider business mailing address

497 MALL RD
OAK HILL WV
25901-6216
US

V. Phone/Fax

Practice location:
  • Phone: 304-469-2905
  • Fax:
Mailing address:
  • Phone: 304-469-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number00322
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number187
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: