Healthcare Provider Details

I. General information

NPI: 1063527240
Provider Name (Legal Business Name): VERONICA JOHNSON BOYKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 MURCHISON RD
FAYETTEVILLE NC
28301-4253
US

IV. Provider business mailing address

6149 SANTA FE DR
FAYETTEVILLE NC
28303-2579
US

V. Phone/Fax

Practice location:
  • Phone: 910-487-9061
  • Fax: 910-488-4553
Mailing address:
  • Phone: 910-487-9061
  • Fax: 910-488-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHC2079
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: