Provider Demographics
NPI:1083249320
Name:BOYD, AARON TATE (PA)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:TATE
Last Name:BOYD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 WINDING RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2917
Mailing Address - Country:US
Mailing Address - Phone:931-206-0891
Mailing Address - Fax:
Practice Address - Street 1:401 SOUTHCREST CIR STE 201
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6721
Practice Address - Country:US
Practice Address - Phone:901-226-0456
Practice Address - Fax:901-226-0458
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4175363AS0400X, 363A00000X
MSPA00501363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant