Healthcare Provider Details

I. General information

NPI: 1861322455
Provider Name (Legal Business Name): DONNA BOYKIN SPEED RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 PROVIDENCE DR
BRANDON MS
39042-7919
US

IV. Provider business mailing address

412 PROVIDENCE DR
BRANDON MS
39042-7919
US

V. Phone/Fax

Practice location:
  • Phone: 601-613-0355
  • Fax: 601-613-0355
Mailing address:
  • Phone: 601-613-0355
  • Fax: 601-613-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-0255
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: