Provider Demographics
NPI:1215217310
Name:BOYKIN, HEATHER M (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7503
Mailing Address - Country:US
Mailing Address - Phone:910-343-9800
Mailing Address - Fax:910-763-4409
Practice Address - Street 1:1302 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7503
Practice Address - Country:US
Practice Address - Phone:910-343-9800
Practice Address - Fax:910-763-4409
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005284363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC2303AOtherMEDICARE PTAN