Healthcare Provider Details

I. General information

NPI: 1366379695
Provider Name (Legal Business Name): JENNIFER R BOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 S TELSHOR BLVD
LAS CRUCES NM
88011-4907
US

IV. Provider business mailing address

4583 SANDALWOOD DR
LAS CRUCES NM
88011-9633
US

V. Phone/Fax

Practice location:
  • Phone: 575-235-7447
  • Fax:
Mailing address:
  • Phone: 575-639-5192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: