Healthcare Provider Details

I. General information

NPI: 1467646851
Provider Name (Legal Business Name): DEBORAH MATTHEWS BOYKIN WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16492 MLC LN SUITE 605
ROCKVILLE VA
23146-1857
US

IV. Provider business mailing address

12600 NIGHTINGALE DR
CHESTER VA
23836-2649
US

V. Phone/Fax

Practice location:
  • Phone: 804-530-1939
  • Fax:
Mailing address:
  • Phone: 804-530-1939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0024066672
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: