Provider Demographics
NPI:1427306000
Name:BROYLES, AMBER DAWN (BA)
Entity type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:DAWN
Last Name:BROYLES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:DAWN
Other - Last Name:TABOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:907 W CADDO ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-4201
Mailing Address - Country:US
Mailing Address - Phone:918-308-5511
Mailing Address - Fax:918-205-2701
Practice Address - Street 1:907 W CADDO ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-4201
Practice Address - Country:US
Practice Address - Phone:918-308-5511
Practice Address - Fax:918-205-2701
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator