Provider Demographics
NPI:1568517910
Name:TANKERSLEY, BOYCE NEAL (NP)
Entity Type:Individual
Prefix:
First Name:BOYCE
Middle Name:NEAL
Last Name:TANKERSLEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4733
Mailing Address - Country:US
Mailing Address - Phone:325-232-8668
Mailing Address - Fax:325-701-9970
Practice Address - Street 1:4716 S 14TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4733
Practice Address - Country:US
Practice Address - Phone:325-232-8668
Practice Address - Fax:325-701-9970
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX641493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ11255Medicare UPIN
TX8J3591Medicare ID - Type Unspecified