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Individual

MS. KELLY BOYD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8085

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1083101
KY
163W00000X
Registered Nurse
281348
OH
367500000X
Certified Registered Nurse Anesthetist
281348
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
28181693A
IN
367500000X
Certified Registered Nurse Anesthetist
5232A
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000597276
ANTHEM PROVIDER NUMBER
IN
05
200472780
IN
05
2467816
OH
05
74007717
KY
Enumeration date
07/21/2005
Last updated
05/02/2013
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