Provider Demographics
NPI:1831373927
Name:POWELL-BOONE, KAREN ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ELAINE
Last Name:POWELL-BOONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2034
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2034
Mailing Address - Country:US
Mailing Address - Phone:828-586-8160
Mailing Address - Fax:828-586-8209
Practice Address - Street 1:SENIOR HEALTH AND EDUCATION PARTNERS
Practice Address - Street 2:5306 NC HWY 55, SUITE 105
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-457-1517
Practice Address - Fax:919-363-7697
Is Sole Proprietor?:No
Enumeration Date:2007-12-25
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY009330363AM0700X
NC0010-01803363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2760093Medicare PIN