Provider Demographics
NPI:1275113961
Name:BOYLAN, KATHRYN LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEIGH
Last Name:BOYLAN
Suffix:
Gender:F
Credentials:MD
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 130094
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0094
Mailing Address - Country:US
Mailing Address - Phone:214-435-0299
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 802
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2726
Practice Address - Country:US
Practice Address - Phone:713-441-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program