Basic Information
Provider Information
NPI: 1003148776
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOYLE
FirstName: KATHLEEN
MiddleName: J
NamePrefix: MRS.
NameSuffix:  
Credential: F.N.P
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 106 CALVERT ST
Address2:  
City: HARRISON
State: NY
PostalCode: 105283131
CountryCode: US
TelephoneNumber: 8452167775
FaxNumber:  
Practice Location
Address1: 106 CALVERT ST
Address2:  
City: HARRISON
State: NY
PostalCode: 105283131
CountryCode: US
TelephoneNumber: 8452167775
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/05/2010
LastUpdateDate: 12/08/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XF332068-1NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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