Healthcare Provider Details

I. General information

NPI: 1811656804
Provider Name (Legal Business Name): TWYLA BOYKIN-BURTON LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36065 SANTA FE AVE
FORT HOOD TX
76544-5060
US

IV. Provider business mailing address

36065 SANTA FE AVE
FORT HOOD TX
76544-5060
US

V. Phone/Fax

Practice location:
  • Phone: 254-553-3147
  • Fax:
Mailing address:
  • Phone: 254-553-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number339585
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: