Healthcare Provider Details

I. General information

NPI: 1366365009
Provider Name (Legal Business Name): PAUL BOONE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5807 HARRODS GLEN DR
PROSPECT KY
40059-7650
US

IV. Provider business mailing address

6613 BURLWOOD DR
LOUISVILLE KY
40229-1445
US

V. Phone/Fax

Practice location:
  • Phone: 502-419-0410
  • Fax:
Mailing address:
  • Phone: 270-314-3034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4061246
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: