Healthcare Provider Details

I. General information

NPI: 1336841626
Provider Name (Legal Business Name): JUSTIN WILLIAM BOYER FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 02/09/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KING'S DAUGHTERS MEDICAL CENTER 12100 PRINCELAND
ASHLAND KY
41102
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 606-928-2963
  • Fax:
Mailing address:
  • Phone: 606-408-6200
  • Fax: 606-408-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3019015
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3019015
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: