Provider Demographics
NPI:1508738279
Name:BOYCE, BURT DALE (NP)
Entity type:Individual
Prefix:
First Name:BURT
Middle Name:DALE
Last Name:BOYCE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:BURTIE
Other - Middle Name:DALE
Other - Last Name:BOYCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:253 DENNY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3907
Mailing Address - Country:US
Mailing Address - Phone:931-802-3090
Mailing Address - Fax:
Practice Address - Street 1:930 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5136
Practice Address - Country:US
Practice Address - Phone:931-536-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40050363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health