Provider Demographics
NPI:1205342995
Name:BOYKIN, BILLY RAY
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:RAY
Last Name:BOYKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-5615
Mailing Address - Country:US
Mailing Address - Phone:501-940-6698
Mailing Address - Fax:501-983-4432
Practice Address - Street 1:5301 MCCLANAHAN DR STE B5
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7079
Practice Address - Country:US
Practice Address - Phone:501-940-6698
Practice Address - Fax:501-983-4432
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)