Provider Demographics
NPI:1295028694
Name:CROSSROADS HEALING ARTS, LLC
Entity type:Organization
Organization Name:CROSSROADS HEALING ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:WHCNP
Authorized Official - Phone:574-294-1883
Mailing Address - Street 1:1004 PARKWAY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9326
Mailing Address - Country:US
Mailing Address - Phone:574-294-1883
Mailing Address - Fax:574-295-1749
Practice Address - Street 1:1004 PARKWAY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9326
Practice Address - Country:US
Practice Address - Phone:574-294-1883
Practice Address - Fax:574-295-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002929A2083P0500X
IN71001272363LW0102X
IN1067015A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty