Healthcare Provider Details

I. General information

NPI: 1669885182
Provider Name (Legal Business Name): KATIE BOYLAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10131 COORS BLVD NW STE H8
ALBUQUERQUE NM
87114-4048
US

IV. Provider business mailing address

10131 COORS BLVD NW STE H8
ALBUQUERQUE NM
87114-4048
US

V. Phone/Fax

Practice location:
  • Phone: 505-207-9044
  • Fax:
Mailing address:
  • Phone: 505-207-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02459
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: