Provider Demographics
NPI:1588089056
Name:BOYD, CHARLOTTE (ANP)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 AUTUMN SPRINGS CT A
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2847
Mailing Address - Country:US
Mailing Address - Phone:615-905-5461
Mailing Address - Fax:615-905-5201
Practice Address - Street 1:3600 BETTE CATO DR
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-9730
Practice Address - Country:US
Practice Address - Phone:907-224-8171
Practice Address - Fax:907-224-8180
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily