Provider Demographics
NPI:1992478747
Name:BOYD, JASMINE (FNP)
Entity type:Individual
Prefix:
First Name:JASMINE
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:PERKINS
Mailing Address - State:OK
Mailing Address - Zip Code:74059-0096
Mailing Address - Country:US
Mailing Address - Phone:405-547-1171
Mailing Address - Fax:405-547-4075
Practice Address - Street 1:101 OK -33
Practice Address - Street 2:
Practice Address - City:PERKINS
Practice Address - State:OK
Practice Address - Zip Code:74059-7405
Practice Address - Country:US
Practice Address - Phone:405-547-1171
Practice Address - Fax:405-547-4075
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0093196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily