Provider Demographics
NPI:1497233225
Name:BOHANON, GINA LEANN (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LEANN
Last Name:BOHANON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 LEXINGTON AVE STE 215
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2833
Practice Address - Country:US
Practice Address - Phone:606-408-4900
Practice Address - Fax:606-408-6643
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV79225363LF0000X
KY3012139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily