Healthcare Provider Details

I. General information

NPI: 1295879062
Provider Name (Legal Business Name): LEISA A BOYKIN WILLSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 STEELE ST
DENVER CO
80206-4479
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 303-372-4000
  • Fax: 303-372-4001
Mailing address:
  • Phone: 970-624-4451
  • Fax: 970-490-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1539
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: