1144464082 NPI number — MS. KAREN A. BOONE RN, MS, PMHCNS

Table of content: CHELSEA J CORDERO RBT (NPI 1912494725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144464082 NPI number — MS. KAREN A. BOONE RN, MS, PMHCNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOONE
Provider First Name:
KAREN
Provider Middle Name:
A.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MS, PMHCNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144464082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
521 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVRE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59501-3649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-395-4305
Provider Business Mailing Address Fax Number:
406-395-5643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVRE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59501-3649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-395-4305
Provider Business Practice Location Address Fax Number:
406-395-5997
Provider Enumeration Date:
04/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0809X , with the licence number:  209.006636 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X , with the licence number: 99997 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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