Provider Demographics
NPI:1063527240
Name:BOYKIN, VERONICA JOHNSON
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:JOHNSON
Last Name:BOYKIN
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 1:6149 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2579
Mailing Address - Country:US
Mailing Address - Phone:910-487-9061
Mailing Address - Fax:910-488-4553
Practice Address - Street 1:1305 MURCHISON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4253
Practice Address - Country:US
Practice Address - Phone:910-487-9061
Practice Address - Fax:910-488-4553
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2079374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600793Medicaid
NC3409364Medicaid