Thomas Boley
Individual provider Active NPI Licensed Practical Nurse · Pryor, OK
NPI 1225413552 · NPPES record last updated Jun 29, 2022
Key facts
- NPI
- 1225413552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- L0057466 (OK)
- Practice address
- 109 N Fairland St
Pryor, OK 74361-4205 - Phone
- (918) 825-1405
- NPI assigned
- Jul 28, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L0057466 | OK | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | L0057466 | OK | Yes |
Addresses
Primary practice location
109 N Fairland St
Pryor, OK 74361-4205
Mailing address
109 N Fairland St
Pryor, OK 74361-4205
Phone (918) 825-1405
NPI Registry JSON
{
"created_epoch": "1438041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656460800000",
"number": "1225413552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 N FAIRLAND ST",
"city": "PRYOR",
"state": "OK",
"postal_code": "743614205",
"telephone_number": "918-825-1405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 N FAIRLAND ST",
"city": "PRYOR",
"state": "OK",
"postal_code": "743614205",
"telephone_number": "918-825-1405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLEY",
"first_name": "THOMAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-28",
"last_updated": "2022-06-29",
"certification_date": "2022-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OK",
"license": "L0057466",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pryor, OK
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- Harry Black
- Alesha Gail Blake
- Blessed Bites Inc
- Sara Blue
- Shyann Bonham
- Keith Boren
- Tanner Daniel Botts
- Karli Ophern Bowles
- Kimberly Dawn Bradley
All providers in Pryor, OK · Licensed Practical Nurse in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.