Provider Demographics
NPI:1952988891
Name:DAY, ELLIOTT BOONE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:BOONE
Last Name:DAY
Suffix:
Gender:M
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 1:8018 POST OAK PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6834
Mailing Address - Country:US
Mailing Address - Phone:502-333-8485
Mailing Address - Fax:
Practice Address - Street 1:1319 DUNCAN AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3759
Practice Address - Country:US
Practice Address - Phone:812-283-2308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2801363A00000X
IN10003510A363A00000X
KYTC063363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant