Individual
CARLY JAY BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2460 N IH 35 E STE 100, WAXAHACHIE, TX 75165-5267
(469) 800-9500
(469) 800-9540
Mailing address
2460 N IH 35 E STE 100, WAXAHACHIE, TX 75165-5267
(469) 800-9500
(469) 800-9540
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA05842
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1082631
CERTIFIED PAC
TX
01
—
PA05842
PHYSCICIAN ASSISTANT LICENSE
TX
Enumeration date
08/07/2008
Last updated
02/19/2024
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