Healthcare Provider Details

I. General information

NPI: 1710909163
Provider Name (Legal Business Name): KEVIN NEAL BOYKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 BERT KOUNS INDUSTRIAL LOOP STE 310
SHREVEPORT LA
71118-3154
US

IV. Provider business mailing address

2508 BERT KOUNS INDUSTRIAL LOOP STE 310
SHREVEPORT LA
71118-3154
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-5880
  • Fax: 318-212-5885
Mailing address:
  • Phone: 318-212-5880
  • Fax: 318-212-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number023569
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number023569
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD.023569
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: