Provider Demographics
NPI:1417444027
Name:BOYKIN, GWEN (LVN)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:
Other - Last Name:BOYKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:19232 COUNTY ROAD 2187 E
Mailing Address - Street 2:
Mailing Address - City:TATUM
Mailing Address - State:TX
Mailing Address - Zip Code:75691-3768
Mailing Address - Country:US
Mailing Address - Phone:903-754-0221
Mailing Address - Fax:
Practice Address - Street 1:19232 COUNTY ROAD 2187 E
Practice Address - Street 2:
Practice Address - City:TATUM
Practice Address - State:TX
Practice Address - Zip Code:75691-3768
Practice Address - Country:US
Practice Address - Phone:903-754-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37974164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse