Provider Demographics
NPI:1144648924
Name:BOYLAN, KRISTINA (FNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BOYLAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PICKERING ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63361-1941
Mailing Address - Country:US
Mailing Address - Phone:573-564-2101
Mailing Address - Fax:573-564-2130
Practice Address - Street 1:240 PICKERING ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CITY
Practice Address - State:MO
Practice Address - Zip Code:63361-1941
Practice Address - Country:US
Practice Address - Phone:573-564-2101
Practice Address - Fax:573-564-2130
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013042560363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily