Healthcare Provider Details

I. General information

NPI: 1215885744
Provider Name (Legal Business Name): KYLE ROCKNE BOYLAN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 EAST TACHEVAH DR. 2 WEST 103
PALM SPRINGS CA
92262
US

IV. Provider business mailing address

2019 NORLOTI ST
PALM SPRINGS CA
92262-4037
US

V. Phone/Fax

Practice location:
  • Phone: 760-464-0023
  • Fax:
Mailing address:
  • Phone: 909-649-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: