MEDICARE: MRS. MARILYNDA S BOYER APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ00041000	NJ
2	363LF0000X	Family Nurse Practitioner	SP007821	PA
3	363LF0000X	Family Nurse Practitioner	0991002	CO
4	363LF0000X	Family Nurse Practitioner	24558	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	026061	OTHER	CO	KAISER COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144202649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARILYNDA S BOYER APN

Provider Business Mailing Address
First Line	:	1801 ORCHARD DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-1945
Country	:	US
Telephone Number	:	609-230-9623
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 N KINGS HWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3037
Country	:	US
Telephone Number	:	843-626-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	01/31/2025

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