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Individual

ASHLEY BOONE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
301 GORDON GUTMANN BLVD STE 401, JEFFERSONVILLE, IN 47130-3768
(812) 282-0637
(812) 283-6330
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002059A
IN
363A00000X
Physician Assistant
50.004170
OH
363A00000X
Physician Assistant
TC225
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0112322
OH
01
10002059A
STATE LICENSE
IN
05
300013731
IN
05
7100448950
KY
01
H410210
MEDICARE PTAN
OH
Enumeration date
10/10/2014
Last updated
02/26/2024
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