Healthcare Provider Details

I. General information

NPI: 1467953000
Provider Name (Legal Business Name): MONICA JEANNE BOYER MHS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 11/07/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MAYFIELD DR
BOYDTON VA
23917-2817
US

IV. Provider business mailing address

175 MAYFIELD DRIVE PO BOX 196
BASKERVILLE VA
23917
US

V. Phone/Fax

Practice location:
  • Phone: 434-447-7613
  • Fax:
Mailing address:
  • Phone: 434-738-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-4228
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126002983
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: