Healthcare Provider Details

I. General information

NPI: 1144464082
Provider Name (Legal Business Name): KAREN A. BOONE RN, MS, PMHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 4TH ST
HAVRE MT
59501-3649
US

IV. Provider business mailing address

521 4TH ST
HAVRE MT
59501-3649
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4305
  • Fax: 406-395-5997
Mailing address:
  • Phone: 406-395-4305
  • Fax: 406-395-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number209.006636
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number99997
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: