Healthcare Provider Details

I. General information

NPI: 1346810835
Provider Name (Legal Business Name): BRANDON HEATH BOYKIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 JAHNKE RD
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

2020 SPRING CRK
COLLEGE STATION TX
77845-4605
US

V. Phone/Fax

Practice location:
  • Phone: 804-483-0745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number870107
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024184535
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: