Provider Demographics
NPI:1891785853
Name:BOYKIN, KATHLEEN RUSH (FNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RUSH
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CHESTNUT CT
Mailing Address - Street 2:
Mailing Address - City:PINE KNOLL SHORES
Mailing Address - State:NC
Mailing Address - Zip Code:28512-6206
Mailing Address - Country:US
Mailing Address - Phone:919-520-5038
Mailing Address - Fax:
Practice Address - Street 1:25 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3219
Practice Address - Country:US
Practice Address - Phone:910-939-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19BM3OtherBCBS OF NC
NCP01487815OtherRAILROAD MEDICARE
NCP01487815OtherRAILROAD MEDICARE