Provider Demographics
NPI:1649570102
Name:BOYER, MISTY COULETTE (CRNA)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:COULETTE
Last Name:BOYER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 CIVIC CIR STE 503
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1843
Mailing Address - Country:US
Mailing Address - Phone:817-877-0350
Mailing Address - Fax:817-529-2667
Practice Address - Street 1:2201 CIVIC CIR
Practice Address - Street 2:SUITE 503
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1848
Practice Address - Country:US
Practice Address - Phone:800-480-1819
Practice Address - Fax:817-334-0235
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571152367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered