Provider Demographics
NPI:1003339623
Name:BOYKO, KATHRYN LYNN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYNN
Last Name:BOYKO
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CENTER RD STE 250A
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2711
Mailing Address - Country:US
Mailing Address - Phone:440-735-2804
Mailing Address - Fax:
Practice Address - Street 1:88 CENTER RD STE 250A
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2711
Practice Address - Country:US
Practice Address - Phone:440-735-2804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0243684Medicaid