Healthcare Provider Details

I. General information

NPI: 1508326042
Provider Name (Legal Business Name): REBECCA ANN BOATMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANN KILKER FNP-C

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 KINGSGATE WAY
WEST CHESTER OH
45069-2453
US

IV. Provider business mailing address

528 FRENCH RUN CT
LEBANON OH
45036-1492
US

V. Phone/Fax

Practice location:
  • Phone: 513-777-1333
  • Fax:
Mailing address:
  • Phone: 513-491-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024434
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.386939
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: