Provider Demographics
NPI:1093250318
Name:BOYLAND, KRYSTAL A (APN)
Entity type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:A
Last Name:BOYLAND
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18692
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38181-0692
Mailing Address - Country:US
Mailing Address - Phone:901-405-0911
Mailing Address - Fax:901-328-1361
Practice Address - Street 1:2829 LAMAR AVE.
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114
Practice Address - Country:US
Practice Address - Phone:901-345-6700
Practice Address - Fax:901-345-6755
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily