Provider Demographics
NPI:1003018763
Name:BOYD, ALYSSE JAYNE
Entity type:Individual
Prefix:MISS
First Name:ALYSSE
Middle Name:JAYNE
Last Name:BOYD
Suffix:
Gender:F
Credentials:
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 74008272
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-8272
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:702-977-1496
Practice Address - Street 1:10955 CAPITAL PKWY
Practice Address - Street 2:
Practice Address - City:CONCORD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44077-9394
Practice Address - Country:US
Practice Address - Phone:312-635-0973
Practice Address - Fax:702-977-1496
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-004144363A00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2661525Medicaid