Provider Demographics
NPI:1669770319
Name:BOYKIN, KEYNIESHA LATRICE (LPN)
Entity type:Individual
Prefix:
First Name:KEYNIESHA
Middle Name:LATRICE
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11119 TUSCORA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3053
Mailing Address - Country:US
Mailing Address - Phone:216-253-7951
Mailing Address - Fax:
Practice Address - Street 1:11119 TUSCORA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3053
Practice Address - Country:US
Practice Address - Phone:216-253-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139692164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse