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General NPI Number Information
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NPI Number | 1245668425
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Entity Type | Individual
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Provider Name | SHANNON ELIZABETH BOYD FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 07/22/2018
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Provider Practice Location Address
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Address Line | 649 SCOTT ST STE 113
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City | TYE
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State | TX
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Zip | 79563
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Country | US
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Telephone | 325-701-7977
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Fax | 325-692-1076
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Provider Business Mailing Address
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Address Line | 649 SCOTT ST STE 113
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City | TYE
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State | TX
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Zip | 79563-2225
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Country | US
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Telephone | 325-701-7977
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Fax | 325-692-1076
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 722902
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License Number State | TX
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