Provider Demographics
NPI:1184192882
Name:BOONE, STEPHEN BRIAN (RN)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:BRIAN
Last Name:BOONE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4774 TIMBERGLEN RD APT 3026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5267
Mailing Address - Country:US
Mailing Address - Phone:972-822-7821
Mailing Address - Fax:
Practice Address - Street 1:4774 TIMBERGLEN RD APT 3026
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-5267
Practice Address - Country:US
Practice Address - Phone:972-822-7821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX822794163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse