Healthcare Provider Details

I. General information

NPI: 1912641663
Provider Name (Legal Business Name): KRISTI LYNN BOHON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KRISTI LYNN BAILEY

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CHURCH ST
PHILIPPI WV
26416-1103
US

IV. Provider business mailing address

PO BOX 146
PHILIPPI WV
26416-0146
US

V. Phone/Fax

Practice location:
  • Phone: 304-457-4545
  • Fax:
Mailing address:
  • Phone: 304-457-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: