MEDICARE: KATIE BOYLAN FNP

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	CNP-02459	NM

General Provider Information

NPI Number	:	1669885182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE BOYLAN FNP

Provider Business Mailing Address
First Line	:	10131 COORS BLVD NW STE H8
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4048
Country	:	US
Telephone Number	:	505-207-9044
Fax Number	:

Provider Business Practice Location Address
First Line	:	10131 COORS BLVD NW STE H8
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4048
Country	:	US
Telephone Number	:	505-207-9044
Fax Number	:

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

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	03/24/2026

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