Provider Demographics
NPI:1508237348
Name:BOYD, DESRON KALINE (LVN)
Entity Type:Individual
Prefix:
First Name:DESRON
Middle Name:KALINE
Last Name:BOYD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2254 PORT TRINITY CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-4801
Mailing Address - Country:US
Mailing Address - Phone:510-862-1057
Mailing Address - Fax:
Practice Address - Street 1:2254 PORT TRINITY CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-4801
Practice Address - Country:US
Practice Address - Phone:510-862-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN221725164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse