Provider Demographics
NPI:1073585162
Name:BOONE, CHRISTIE ANN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:ANN
Last Name:BOONE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:285 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-9484
Mailing Address - Country:US
Mailing Address - Phone:859-338-2655
Mailing Address - Fax:270-659-9797
Practice Address - Street 1:211 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3486
Practice Address - Country:US
Practice Address - Phone:270-659-9696
Practice Address - Fax:270-659-9797
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYPA905363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical