Provider Demographics
NPI:1437238185
Name:BOYLE, KINDRA ROXANNE (LMP)
Entity Type:Individual
Prefix:MS
First Name:KINDRA
Middle Name:ROXANNE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14217 NE 91ST ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-2685
Mailing Address - Country:US
Mailing Address - Phone:360-909-1267
Mailing Address - Fax:
Practice Address - Street 1:5512 NE 109TH CT STE I
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6175
Practice Address - Country:US
Practice Address - Phone:360-909-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist