Healthcare Provider Details

I. General information

NPI: 1053993865
Provider Name (Legal Business Name): BRITTANY BOYKIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 LAKELAND DR
JACKSON MS
39216-4606
US

IV. Provider business mailing address

PO BOX 677957
DALLAS TX
75267-7957
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-5900
  • Fax: 601-200-5959
Mailing address:
  • Phone: 225-765-5727
  • Fax: 225-765-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904332
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: