Provider Demographics
NPI:1710909163
Name:BOYKIN, KEVIN NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:NEAL
Last Name:BOYKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 BERT KOUNS INDUSTRIAL LOOP STE 310
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3154
Mailing Address - Country:US
Mailing Address - Phone:318-212-5880
Mailing Address - Fax:318-212-5885
Practice Address - Street 1:2508 BERT KOUNS INDUSTRIAL LOOP STE 310
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3154
Practice Address - Country:US
Practice Address - Phone:318-212-5880
Practice Address - Fax:318-212-5885
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023569208600000X, 2086S0120X
LAMD.0235692086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1486507Medicaid
LA5H862CQ62Medicare PIN
LA5H862Medicare PIN
LAH27615Medicare UPIN