1598304867 NPI number — KAYLA ASHLEY BOYLEN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598304867 NPI number — KAYLA ASHLEY BOYLEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYLEN
Provider First Name:
KAYLA
Provider Middle Name:
ASHLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
KAYLA
Provider Other Middle Name:
ASHLEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598304867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 E COURT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGWOOD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26537-1437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-329-3030
Provider Business Mailing Address Fax Number:
304-329-3031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 E COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGWOOD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26537-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-329-3030
Provider Business Practice Location Address Fax Number:
304-329-3031
Provider Enumeration Date:
01/03/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  105138 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)