Provider Demographics
NPI:1629366786
Name:BOYLES, PRESTON HEATH (ARNP-C)
Entity Type:Individual
Prefix:MR
First Name:PRESTON
Middle Name:HEATH
Last Name:BOYLES
Suffix:
Gender:M
Credentials:ARNP-C
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 166
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-0166
Mailing Address - Country:US
Mailing Address - Phone:580-756-4076
Mailing Address - Fax:580-756-4077
Practice Address - Street 1:311 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055-2441
Practice Address - Country:US
Practice Address - Phone:580-756-4076
Practice Address - Fax:580-756-4077
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK82777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily