Provider Demographics
NPI:1427178797
Name:BOUGHNER, AARON MICHAEL
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:MICHAEL
Last Name:BOUGHNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52890 SR 145
Mailing Address - Street 2:
Mailing Address - City:BEALLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43716
Mailing Address - Country:US
Mailing Address - Phone:740-512-6616
Mailing Address - Fax:
Practice Address - Street 1:52890 SR 145
Practice Address - Street 2:
Practice Address - City:BEALLSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43716
Practice Address - Country:US
Practice Address - Phone:740-512-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2473452OtherINDEPENDENT PROVIDER