Basic Information
| Provider Information | |||||||||
| NPI: | 1639531254 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYD | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RDN, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2412 50TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794122504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067884000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2412 50 TH STREET | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067884000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2016 | ||||||||
| LastUpdateDate: | 03/23/2016 | ||||||||
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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 | 133V00000X | DT84123 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.