Provider Demographics
NPI:1881403293
Name:BOYD, ANNIE ROSE (APP)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:ROSE
Last Name:BOYD
Suffix:
Gender:F
Credentials:APP
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:ROSE
Other - Last Name:ELIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APP
Mailing Address - Street 1:4209 LAKERIDGE DR E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6704
Mailing Address - Country:US
Mailing Address - Phone:253-820-6951
Mailing Address - Fax:
Practice Address - Street 1:2102 N PEARL ST STE 405
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2550
Practice Address - Country:US
Practice Address - Phone:253-752-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-01
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61624721363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health