Lennis K Boyer, MD
Individual provider Active NPI Pediatrics Physician · Pullman, WA
NPI 1689657488 · NPPES record last updated Jan 13, 2011
Key facts
- NPI
- 1689657488
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- MD0027662 (WA)
- Practice address
- 1205 SE Professional Mall Blvd
Suite 104
Pullman, WA 99163-5423 - Phone
- (509) 332-2605
- Fax
- (509) 334-5754
- NPI assigned
- Nov 25, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M5747 | ID | MD | Pediatrics Physician |
| MD0027662 | WA | MD | Pediatrics Physician |
Interoperability endpoints
- lennis.boyer@prh.gwaydirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD0027662 | WA | Yes |
| Pediatrics Physician | 208000000X | M5747 | ID |
Addresses
Primary practice location
1205 SE Professional Mall Blvd
Suite 104
Pullman, WA 99163-5423
Mailing address
1205 SE Professional Mall Blvd
Suite 104
Pullman, WA 99163-5423
Phone (509) 332-2605
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8124323 | Medicaid | WA |
Other providers in Pullman, WA
- Stephanie L Boone
- Boost Collaborative
- Michelle A Bower
- Jonathan Bowman
- Jeana Boyd
- Kristine Ellen Brenc
- Anthony Demetris Bright
- Brighton Rehabilitation LLC
- Brighton Rehabilitation, LLC
- Michael David Brodeur
All providers in Pullman, WA · Pediatrics Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.