Provider Demographics
NPI:1316459357
Name:BOYD, BERNITA DANICA
Entity type:Individual
Prefix:
First Name:BERNITA
Middle Name:DANICA
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 THEATER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-5024
Mailing Address - Country:US
Mailing Address - Phone:434-233-7718
Mailing Address - Fax:434-757-2218
Practice Address - Street 1:436 THEATER RD
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970
Practice Address - Country:US
Practice Address - Phone:571-444-3106
Practice Address - Fax:434-757-2218
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0Medicaid