1710207808 NPI number — SUZETTE NICOLE BOYD APN

Table of content: SUZETTE NICOLE BOYD APN (NPI 1710207808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710207808 NPI number — SUZETTE NICOLE BOYD APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
SUZETTE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710207808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 512
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEWITT
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72042-0512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-946-3637
Provider Business Mailing Address Fax Number:
870-946-4410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1641 SOUTH WHITEHEAD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEWITT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72042-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-946-3637
Provider Business Practice Location Address Fax Number:
870-946-4409
Provider Enumeration Date:
06/11/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  A03371 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)