Provider Demographics
NPI:1194788216
Name:BOYD, ELLEN (FNP)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 REGIONAL PLZ
Mailing Address - Street 2:SUITE 1070
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5262
Mailing Address - Country:US
Mailing Address - Phone:325-695-7355
Mailing Address - Fax:325-695-5131
Practice Address - Street 1:6250 REGIONAL PLZ
Practice Address - Street 2:SUITE 1070
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5262
Practice Address - Country:US
Practice Address - Phone:325-695-7355
Practice Address - Fax:325-695-5131
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX516158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P89500Medicare UPIN