Provider Demographics
NPI:1376025601
Name:BOYLES, LAURA VICTORIA (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:VICTORIA
Last Name:BOYLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:VICTORIA
Other - Last Name:NANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:1 E CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:ELLSINORE
Practice Address - State:MO
Practice Address - Zip Code:63937
Practice Address - Country:US
Practice Address - Phone:573-429-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018004081363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty