Provider Demographics
NPI:1760877658
Name:BOEHM, NANCY KAY (FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KAY
Last Name:BOEHM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5266
Mailing Address - Country:US
Mailing Address - Phone:910-346-2273
Mailing Address - Fax:
Practice Address - Street 1:308 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5266
Practice Address - Country:US
Practice Address - Phone:910-346-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC197186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily