Healthcare Provider Details

I. General information

NPI: 1538766092
Provider Name (Legal Business Name): LAUREN BOYLES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN STE C685
DALLAS TX
75230-6885
US

IV. Provider business mailing address

5705 WILMINGTON DR
FRISCO TX
75035-7963
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-7799
  • Fax:
Mailing address:
  • Phone: 214-714-7983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1016099
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: