Provider Demographics
NPI:1841892791
Name:BOYD, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
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:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:BLUE ROCK
Mailing Address - State:OH
Mailing Address - Zip Code:43720-0156
Mailing Address - Country:US
Mailing Address - Phone:740-336-9022
Mailing Address - Fax:
Practice Address - Street 1:1046 N KENNEBEC AVE
Practice Address - Street 2:
Practice Address - City:MCCONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-1015
Practice Address - Country:US
Practice Address - Phone:740-651-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide