Healthcare Provider Details

I. General information

NPI: 1467374561
Provider Name (Legal Business Name): JASPER KENDALE BOYCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 CLIFF CAMERON DR
CHARLOTTE NC
28269-5906
US

IV. Provider business mailing address

880 BREEZE CT
CONCORD NC
28027-6934
US

V. Phone/Fax

Practice location:
  • Phone: 615-560-6622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: