Provider Demographics
NPI:1033458070
Name:BOYLES, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BOYLES
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:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:LANGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73050-0586
Mailing Address - Country:US
Mailing Address - Phone:405-837-6208
Mailing Address - Fax:
Practice Address - Street 1:1732 N KELLY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73111
Practice Address - Country:US
Practice Address - Phone:405-471-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator