1922083930 NPI number — MS. RUTH ELLEN BOYNTON NURSE PRACTITIONER

Table of content: MS. RUTH ELLEN BOYNTON NURSE PRACTITIONER (NPI 1922083930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922083930 NPI number — MS. RUTH ELLEN BOYNTON NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYNTON
Provider First Name:
RUTH
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOYNTON
Provider Other First Name:
RUTH
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, APN-BC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922083930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37367-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-447-2992
Provider Business Mailing Address Fax Number:
423-447-2994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3062 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37367-5746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-447-2955
Provider Business Practice Location Address Fax Number:
423-447-2405
Provider Enumeration Date:
12/13/2005

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: 363L00000X , with the licence number:  APN 7766 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1509816 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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