MEDICARE: MRS. KATHLEEN A BOONE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	F1372	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538143391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN A BOONE FNP

Provider Business Mailing Address
First Line	:	PO BOX 421718
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29442-4203
Country	:	US
Telephone Number	:	843-652-8226
Fax Number	:

Provider Business Practice Location Address
First Line	:	9699 OCEAN HWY
Second Line	:	WACCMAAW MEDICAL CENTER
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-7425
Country	:	US
Telephone Number	:	843-237-4296
Fax Number	:	843-237-0495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	03/05/2021

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