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General NPI Number Information
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NPI Number | 1558938530
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Entity Type | Individual
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Provider Name | COURTNEY BOONE PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 14180 DALLAS PKWY
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City | DALLAS
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State | TX
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Zip | 75254-4341
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Country | US
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Telephone | 469-391-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 5009 WHITE SETTLEMENT RD APT 1401
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City | FORT WORTH
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State | TX
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Zip | 76114-3957
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Country | US
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Telephone | 325-669-5745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA14763
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License Number State | TX
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