MEDICARE: BRETTENY LACOLE BOYD MSN, APRN, FNP-C

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	363L00000X	Nurse Practitioner	36343	TN

General Provider Information

NPI Number	:	1255652889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETTENY LACOLE BOYD MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	1057 BRAYDEN DR
Second Line	:
City	:	FAIRVIEW
State	:	TN
Zip	:	37062-1421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 E COLLEGE ST
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2032
Country	:	US
Telephone Number	:	615-560-7016
Fax Number	:

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/20/2024

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