Provider Demographics
NPI:1811478142
Name:BOEN, CHRISTY (CNS)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:BOEN
Suffix:
Gender:
Credentials:CNS
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACCNS-AG
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:575-769-7577
Mailing Address - Fax:575-742-7856
Practice Address - Street 1:2421 W 21ST ST STE B
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-2006
Practice Address - Country:US
Practice Address - Phone:575-769-7577
Practice Address - Fax:575-742-7856
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83365364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist