Provider Demographics
NPI:1942889795
Name:BOVARD, NASH
Entity Type:Individual
Prefix:
First Name:NASH
Middle Name:
Last Name:BOVARD
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:UNIT 100335 BOX 1
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96693-3500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USS MISSOURI (SSN 780)
Practice Address - Street 2:UNIT 100335
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96693
Practice Address - Country:US
Practice Address - Phone:224-254-7468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman