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General NPI Number Information
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NPI Number | 1699073916
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Entity Type | Individual
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Provider Name | ELLEN M BOYNTON PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 9701 LANDMARK PARKWAY DR STE 207
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1665
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Country | US
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Telephone | 314-849-8700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 874797
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City | KANSAS CITY
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State | MO
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Zip | 64187-4797
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Country | US
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Telephone | 314-849-8700
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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 | 52534
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 20240478142
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License Number State | MO
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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 | 085004009
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License Number State | IL
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