Healthcare Provider Details

I. General information

NPI: 1376859686
Provider Name (Legal Business Name): SHERRY BOYLEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 BALDWIN BRANCH RD
ANNVILLE KY
40402-8657
US

IV. Provider business mailing address

1272 BALDWIN BRANCH RD
ANNVILLE KY
40402-8657
US

V. Phone/Fax

Practice location:
  • Phone: 606-364-3703
  • Fax: 606-364-3703
Mailing address:
  • Phone: 606-364-3703
  • Fax: 606-364-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1097620
License Number StateKY

VIII. Authorized Official

Name: SHERRY LYNN BOYLEN
Title or Position: REGISTERED NURSE
Credential: LISCENSED NURSE
Phone: 606-364-3703