Provider Demographics
NPI:1417127564
Name:BOYLE, HEATHER KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:KATHLEEN
Last Name:BOYLE
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 1:1515 N SAN FRANCISCO ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1435
Mailing Address - Country:US
Mailing Address - Phone:928-774-0108
Mailing Address - Fax:928-774-2801
Practice Address - Street 1:1515 N SAN FRANCISCO ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1435
Practice Address - Country:US
Practice Address - Phone:928-774-0108
Practice Address - Fax:928-774-2801
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38148207R00000X, 2084P0800X
IL0361173292084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry