Healthcare Provider Details

I. General information

NPI: 1811478142
Provider Name (Legal Business Name): CHRISTY BOEN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY COOPER ACCNS-AG

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 W 21ST ST STE B
CLOVIS NM
88101-2006
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-7577
  • Fax: 575-742-7856
Mailing address:
  • Phone: 575-769-7577
  • Fax: 575-742-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number83365
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: