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NPI Code Detail

MEDICARE: MRS. JENNIFER NICOLE BOYD BHRS

MEDICARE: MRS. JENNIFER NICOLE BOYD BHRS
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1114264561
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER NICOLE BOYD BHRS
Provider Business Mailing Address
First Line : 102438 S 4621 RD
Second Line :
City : SALLISAW
State : OK
Zip : 74955-8991
Country : US
Telephone Number : 918-315-1421
Fax Number :
Provider Business Practice Location Address
First Line : 1108 N WHEELER AVE
Second Line :
City : SALLISAW
State : OK
Zip : 74955-2227
Country : US
Telephone Number : 918-775-5513
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2013
Last Update Date : 01/14/2019

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