Provider Demographics
NPI:1962252486
Name:BOATFIELD, CAROLYNN R (PA-C)
Entity type:Individual
Prefix:MISS
First Name:CAROLYNN
Middle Name:R
Last Name:BOATFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462
Mailing Address - Country:US
Mailing Address - Phone:309-734-1414
Mailing Address - Fax:309-734-0323
Practice Address - Street 1:1000 W HARLEM AVE
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462
Practice Address - Country:US
Practice Address - Phone:309-734-1414
Practice Address - Fax:309-734-0323
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant