Provider Demographics
NPI:1922083930
Name:BOYNTON, RUTH ELLEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ELLEN
Last Name:BOYNTON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:RUTH
Other - Middle Name:ELLEN
Other - Last Name:BOYNTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, APN-BC
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37367-0190
Mailing Address - Country:US
Mailing Address - Phone:423-447-2992
Mailing Address - Fax:423-447-2994
Practice Address - Street 1:3062 MAIN ST
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37367-5746
Practice Address - Country:US
Practice Address - Phone:423-447-2955
Practice Address - Fax:423-447-2405
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 7766363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509816Medicaid
TN10350I2985Medicare PIN