Individual
BOONE WILFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
639 HOSPITAL DR, MOUNTAIN HOME, AR 72653-2914
(479) 587-1700
(479) 587-1366
Mailing address
3901 PARKWAY CIR, SPRINGDALE, AR 72762-6362
(479) 587-1700
(479) 587-1366
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2015001252
MO
363L00000X
Nurse Practitioner
Primary
221970
AR
363L00000X
Nurse Practitioner
AP61495401
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487044962
—
MO
05
—
420020610
—
MO
Enumeration date
02/04/2015
Last updated
01/10/2025
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