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General NPI Number Information
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NPI Number | 1801052030
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Entity Type | Individual
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Provider Name | CARLY JAY BOONE PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 2460 N IH 35 E STE 100
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City | WAXAHACHIE
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State | TX
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Zip | 75165-5267
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Country | US
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Telephone | 469-800-9500
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Fax | 469-800-9540
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Provider Business Mailing Address
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Address Line | 2460 N IH 35 E STE 100
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City | WAXAHACHIE
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State | TX
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Zip | 75165-5267
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Country | US
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Telephone | 469-800-9500
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Fax | 469-800-9540
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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 | PA05842
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License Number State | TX
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