MEDICARE: TARA DAVIS-BOYD NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	23509	SC

General Provider Information

NPI Number	:	1033749643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA DAVIS-BOYD NP

Provider Business Mailing Address
First Line	:	335 LAKE FRANCES DR
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29170-3871
Country	:	US
Telephone Number	:	210-616-1282
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 HIGHWAY 17 BYP S
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4500
Country	:	US
Telephone Number	:	843-830-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	01/22/2020

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