Basic Information
| Provider Information | |||||||||
| NPI: | 1265936686 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | KENYSHA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5350 CAMELOT DR APT 22 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450147430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134094121 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 621 S ERIE HWY | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450114315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137957557 | ||||||||
| FaxNumber: | 5137374603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2018 | ||||||||
| LastUpdateDate: | 03/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 139562 | OH | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.