Individual
LACY BOYD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2721 W PARK DR, PADUCAH, KY 42001-9058
(270) 554-7546
(270) 554-0316
Mailing address
2721 W PARK DR, PADUCAH, KY 42001-9058
(270) 554-7546
(270) 554-0316
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA1142
KY
363AM0700X
Medical Physician Assistant
Primary
PA1142
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000755001
ANTHEM
KY
01
—
P01058489
RR MEDICARE
KY
Enumeration date
06/01/2009
Last updated
03/30/2015
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