Healthcare Provider Details

I. General information

NPI: 1134198195
Provider Name (Legal Business Name): KATHLEEN ANN BOYLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANN SORIA MD

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S 101ST EAST AVE STE 200
TULSA OK
74133-5730
US

IV. Provider business mailing address

8803 S 101ST EAST AVE STE 200
TULSA OK
74133-5730
US

V. Phone/Fax

Practice location:
  • Phone: 918-307-2273
  • Fax: 918-307-0273
Mailing address:
  • Phone: 918-307-2273
  • Fax: 918-307-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17805
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number17805
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: