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General NPI Number Information
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NPI Number | 1437644788
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Entity Type | Individual
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Provider Name | TIELISIA ANN BOYD
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Gender | Female
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 8906 E SKELLY DR
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City | TULSA
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State | OK
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Zip | 74129-3400
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Country | US
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Telephone | 918-301-0210
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Fax | 918-217-1325
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Provider Business Mailing Address
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Address Line | 8906 E SKELLY DR
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City | TULSA
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State | OK
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Zip | 74129-3400
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Country | US
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Telephone | 918-301-0210
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Fax | 918-217-1325
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 37V881621299
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License Number State | OK
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