MEDICARE: MRS. GINA LEANN BOHANON MSN, APRN, FNP-C

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	79225	WV
2	363LF0000X	Family Nurse Practitioner	3012139	KY

General Provider Information

NPI Number	:	1497233225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA LEANN BOHANON MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1595
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41105-1595
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 LEXINGTON AVE STE 215
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-2833
Country	:	US
Telephone Number	:	606-408-4900
Fax Number	:	606-408-6643

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

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	09/27/2022

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