Provider Demographics
NPI:1730172354
Name:BOYD, JENNIFER A (PA C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BOYD
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:STURR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:497 MALL RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-6216
Mailing Address - Country:US
Mailing Address - Phone:304-469-2905
Mailing Address - Fax:
Practice Address - Street 1:497 MALL RD
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-6216
Practice Address - Country:US
Practice Address - Phone:304-469-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00322363A00000X
WV187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV38100000502Medicaid
WV2029497Medicare PIN
WV2029495Medicare PIN
WV2029496Medicare PIN