Provider Demographics
NPI:1134198195
Name:BOYLS, KATHLEEN ANN (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:BOYLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:SORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8803 S 101ST EAST AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5730
Mailing Address - Country:US
Mailing Address - Phone:918-307-2273
Mailing Address - Fax:918-307-0273
Practice Address - Street 1:8803 S 101ST EAST AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5730
Practice Address - Country:US
Practice Address - Phone:918-307-2273
Practice Address - Fax:918-307-0273
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17805208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20079950BMedicaid