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General NPI Number Information
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NPI Number | 1649430778
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Entity Type | Individual
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Provider Name | TERRY W BOONE PAC
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Gender | Male
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 308 S MAIN ST
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City | MARION
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State | KY
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Zip | 42064-1545
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Country | US
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Telephone | 270-965-4377
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Fax | 270-965-9569
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Provider Business Mailing Address
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Address Line | PO BOX 347
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City | SALEM
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State | KY
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Zip | 42078-0347
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Country | US
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Telephone | 270-988-3298
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Fax | 270-988-4642
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1128
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License Number State | KY
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