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General NPI Number Information
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NPI Number | 1831692664
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Entity Type | Individual
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Provider Name | ALICIA RAY BASHKIHARATEE BOYD CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/18/2018
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Last Update Date | 03/18/2018
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Provider Practice Location Address
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Address Line | 8375 HIGHWAY 72 W
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City | MADISON
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State | AL
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Zip | 35758-9573
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Country | US
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Telephone | 256-265-5001
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Fax |
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Provider Business Mailing Address
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Address Line | 6941 HIGHWAY 72 W APT 7110
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City | HUNTSVILLE
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State | AL
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Zip | 35806-2886
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Country | US
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Telephone | 985-628-2104
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-114347
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License Number State | AL
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