Individual provider Active NPI

Angela Blair Boykin, LPN

  • Licensed Practical Nurse
  • Bridgeport, CT
National Provider Identifier
1003108572
Registry record updated May 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
278790 Issued in NY
Practice address
115 Brittin Ave
Bridgeport, CT 06605-3419
Phone
(203) 870-1751
Fax
(203) 870-1751
NPI assigned
May 3, 2011
Last updated
May 3, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 11.035623 CT
Licensed Practical Nurse 164W00000X 278790 NY Primary

Addresses

Primary practice location

115 Brittin Ave
Bridgeport, CT 06605-3419

Mailing address

115 Brittin Ave
Bridgeport, CT 06605-3419
Phone (203) 870-1751

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11.035623CTMDLicensed Practical Nurse
278790NYMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304380800000",
    "number": "1003108572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 BRITTIN AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066053419",
            "telephone_number": "203-870-1751",
            "fax_number": "203-870-1751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 BRITTIN AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066053419",
            "telephone_number": "203-870-1751",
            "fax_number": "203-870-1751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIR BOYKIN",
        "first_name": "ANGELA",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-03",
        "last_updated": "2011-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "CT",
            "license": "11.035623",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "278790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.