Healthcare Provider Details

I. General information

NPI: 1215055637
Provider Name (Legal Business Name): TROY EVANS BOOVY RN, NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 STATESVILLE BLVD
SALISBURY NC
28147-1411
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR SUITE 100
CONCORD NC
28025-1894
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-3616
  • Fax: 704-633-5902
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201792
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201792
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: