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NPI Code Detail

MEDICARE: MS. JESSICA ANN BOYLE

MEDICARE: MS. JESSICA ANN BOYLE
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
1163WP0808XPsychiatric/Mental Health Registered NurseRN170737GA

General Provider Information

NPI Number : 1649961954
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA ANN BOYLE
Provider Business Mailing Address
First Line : 3302 MILLHOLLOW TER
Second Line :
City : BUFORD
State : GA
Zip : 30519-7933
Country : US
Telephone Number : 770-401-1968
Fax Number :
Provider Business Practice Location Address
First Line : 1325 SATELLITE BLVD NW STE 400
Second Line :
City : SUWANEE
State : GA
Zip : 30024-5299
Country : US
Telephone Number : 678-263-3080
Fax Number : 678-496-9863
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2023
Last Update Date : 05/17/2023

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