MEDICARE: KERRY ANN BOYER FNP

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
1	363LF0000X	Family Nurse Practitioner	0024173015	VA

General Provider Information

NPI Number	:	1265803001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY ANN BOYER FNP

Provider Business Mailing Address
First Line	:	7493 RIGHT FLANK RD
Second Line	:	SUITE 400
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3846
Country	:	US
Telephone Number	:	804-559-2916
Fax Number	:	804-559-9206

Provider Business Practice Location Address
First Line	:	7493 RIGHT FLANK RD
Second Line	:	SUITE 400
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3846
Country	:	US
Telephone Number	:	804-559-2916
Fax Number	:	804-559-9206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2015
Last Update Date	:	10/19/2015

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