Provider Demographics
NPI:1902163215
Name:BOYD, JENNIFER EMILY (LMP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:EMILY
Last Name:BOYD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26659 MYRTLE LANE NE APT.102
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346
Mailing Address - Country:US
Mailing Address - Phone:360-516-0743
Mailing Address - Fax:
Practice Address - Street 1:26659 MYRTLE LN NE APT 102
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9464
Practice Address - Country:US
Practice Address - Phone:360-516-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60265601171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor