Provider Demographics
NPI:1346557550
Name:BOYLE, ROBERT BRYAN (APRN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRYAN
Last Name:BOYLE
Suffix:
Gender:
Credentials:APRN
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 5090
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77325-5090
Mailing Address - Country:US
Mailing Address - Phone:713-481-2808
Mailing Address - Fax:713-481-2805
Practice Address - Street 1:3421 W 9TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5401
Practice Address - Country:US
Practice Address - Phone:319-272-8922
Practice Address - Fax:319-272-8929
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2372566363LP0808X
IAG168653363LP0808X
WAAP61305143363LP0808X
AZ278359363LP0808X
OR10016393363LP0808X
TX1032748363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215902201Medicaid