Provider Demographics
NPI:1699545657
Name:BOYKIN, SHAWNDA
Entity type:Individual
Prefix:
First Name:SHAWNDA
Middle Name:
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 1:3810 EILEEN LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-2022
Mailing Address - Country:US
Mailing Address - Phone:318-465-8546
Mailing Address - Fax:
Practice Address - Street 1:3810 EILEEN LN
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-2022
Practice Address - Country:US
Practice Address - Phone:318-465-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)