Provider Demographics
NPI:1326267816
Name:BOE, S.KATHRYN (MSN)
Entity Type:Individual
Prefix:MS
First Name:S.KATHRYN
Middle Name:
Last Name:BOE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8545 CHEVY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5369
Mailing Address - Country:US
Mailing Address - Phone:619-464-1384
Mailing Address - Fax:
Practice Address - Street 1:9415 CAMPUS POINTE DR
Practice Address - Street 2:MAIL CODE - 0946
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0946
Practice Address - Country:US
Practice Address - Phone:858-534-6290
Practice Address - Fax:858-822-1849
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP6742363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA491356OtherRN LICENSE
CA6742OtherNP LICENSE