=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134198195
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN ANN BOYLS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2006
-----------------------------------------------------
Last Update Date | 07/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8803 S 101ST EAST AVE STE 200
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-5730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-307-2273
-----------------------------------------------------
Fax | 918-307-0273
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8803 S 101ST EAST AVE STE 200
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-5730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-307-2273
-----------------------------------------------------
Fax | 918-307-0273
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 17805
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number | 17805
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------