Basic Information
Provider Information | |||||||||
NPI: | 1548500010 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BOYKIN-WRIGHT | ||||||||
FirstName: | LAKISHA | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BOYKIN WRIGHT | ||||||||
OtherFirstName: | LAKISHA | ||||||||
OtherMiddleName: | M. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | APRN | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1624 MAIN STREET | ||||||||
Address2: | DBA LTC HEALTH SOLUTIONS | ||||||||
City: | COLUMBIA | ||||||||
State: | SC | ||||||||
PostalCode: | 292012818 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8037262350 | ||||||||
FaxNumber: | 8037539102 | ||||||||
Practice Location | |||||||||
Address1: | 1053 CENTER STREET | ||||||||
Address2: | DBA LTC HEALTH SOLUTIONS | ||||||||
City: | WEST COLUMBIA | ||||||||
State: | SC | ||||||||
PostalCode: | 29169 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8004910909 | ||||||||
FaxNumber: | 8433532581 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/21/2013 | ||||||||
LastUpdateDate: | 12/21/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 18182 | SC | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | NP2424 | 05 | SC |   | MEDICAID |