Healthcare Provider Details

I. General information

NPI: 1699073916
Provider Name (Legal Business Name): ELLEN M BOYNTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN M MCGUIGAN

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 LANDMARK PARKWAY DR STE 207
SAINT LOUIS MO
63127-1665
US

IV. Provider business mailing address

PO BOX 874797
KANSAS CITY MO
64187-4797
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-8700
  • Fax:
Mailing address:
  • Phone: 314-849-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52534
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number20240478142
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085004009
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: