Provider Demographics
NPI:1700328523
Name:BOYLE, EMILY MAIRE (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MAIRE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LOCHHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8020
Mailing Address - Country:US
Mailing Address - Phone:314-578-5400
Mailing Address - Fax:
Practice Address - Street 1:4122 KEATON CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8218
Practice Address - Country:US
Practice Address - Phone:636-329-9077
Practice Address - Fax:636-329-9076
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016039315363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health