Provider Demographics
NPI:1578306775
Name:BOYCE, JACKIE ANNE
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:ANNE
Last Name:BOYCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 STORMS RD
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320-6437
Mailing Address - Country:US
Mailing Address - Phone:843-269-1012
Mailing Address - Fax:
Practice Address - Street 1:1294 STORMS RD
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320-6437
Practice Address - Country:US
Practice Address - Phone:843-269-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program