Provider Demographics
NPI:1134371545
Name:BOYD, BERNADETTE CORDARO (NP)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:CORDARO
Last Name:BOYD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3322
Mailing Address - Country:US
Mailing Address - Phone:318-746-1094
Mailing Address - Fax:
Practice Address - Street 1:1518 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3322
Practice Address - Country:US
Practice Address - Phone:318-746-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN0408020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily