Healthcare Provider Details

I. General information

NPI: 1679931778
Provider Name (Legal Business Name): CONNIE RENEE BOEHMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE RENEE KIESLING FNP-C

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E WALNUT ST STE A
EVANSVILLE IN
47713-2460
US

IV. Provider business mailing address

3923 CROSS CREEK TRL
OWENSBORO KY
42303-1895
US

V. Phone/Fax

Practice location:
  • Phone: 844-999-9019
  • Fax:
Mailing address:
  • Phone: 812-719-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010041
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006571A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201318
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: