Provider Demographics
NPI:1952390791
Name:BOAZ, KATHERINE HOOKER (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:HOOKER
Last Name:BOAZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 BUDD LN
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:VA
Mailing Address - Zip Code:24122-2793
Mailing Address - Country:US
Mailing Address - Phone:540-947-0159
Mailing Address - Fax:
Practice Address - Street 1:295 COMMONWEALTH BLVD W
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1820
Practice Address - Country:US
Practice Address - Phone:276-638-2311
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024070731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily