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NPI Code Detail

MEDICARE: MRS. CHRISTIE ANN BOONE PAC

MEDICARE: MRS. CHRISTIE ANN BOONE PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA905KY

General Provider Information

NPI Number : 1073585162
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHRISTIE ANN BOONE PAC
Provider Business Mailing Address
First Line : 310 N L ROGERS WELLS BLVD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-1300
Country : US
Telephone Number : 270-659-5870
Fax Number : 270-659-5851
Provider Business Practice Location Address
First Line : 310 N L ROGERS WELLS BLVD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-1300
Country : US
Telephone Number : 270-659-5870
Fax Number : 270-659-5851
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 08/06/2025

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Directions to “ MRS. CHRISTIE ANN BOONE PAC” Practice Location

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