Provider Demographics
NPI:1356333090
Name:BOYLES, MELISSA A (PHD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BOYLES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 FRANKFORT AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2682
Mailing Address - Country:US
Mailing Address - Phone:502-432-1611
Mailing Address - Fax:502-893-4043
Practice Address - Street 1:2915 FRANKFORT AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2682
Practice Address - Country:US
Practice Address - Phone:502-432-1611
Practice Address - Fax:502-893-4043
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1351103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3001417Medicare ID - Type Unspecified
KYQ22932Medicare UPIN