Provider Demographics
NPI:1346284841
Name:BOECKMANN, KATHEY DIANNE (APN)
Entity Type:Individual
Prefix:
First Name:KATHEY
Middle Name:DIANNE
Last Name:BOECKMANN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 COUNTY ROAD 628
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-8424
Mailing Address - Country:US
Mailing Address - Phone:870-588-5256
Mailing Address - Fax:870-238-4569
Practice Address - Street 1:704 CANAL AVE E
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3042
Practice Address - Country:US
Practice Address - Phone:870-239-2101
Practice Address - Fax:870-238-4569
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01022363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health