Provider Demographics
NPI:1831496603
Name:BOYETTE, ALEZA MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ALEZA
Middle Name:MARIE
Last Name:BOYETTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALEZA
Other - Middle Name:MARIE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1464
Mailing Address - Country:US
Mailing Address - Phone:601-264-0929
Mailing Address - Fax:
Practice Address - Street 1:5192 OLD HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-6222
Practice Address - Country:US
Practice Address - Phone:601-268-0929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR876535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily