Basic Information
| Provider Information | |||||||||
| NPI: | 1144464082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOONE | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RN, MS, PMHCNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 521 4TH ST | ||||||||
| Address2: | |||||||||
| City: | HAVRE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 595013649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063954305 | ||||||||
| FaxNumber: | 4063955643 | ||||||||
| Practice Location | |||||||||
| Address1: | 521 4TH ST | ||||||||
| Address2: | |||||||||
| City: | HAVRE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 595013649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063954305 | ||||||||
| FaxNumber: | 4063955997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2009 | ||||||||
| LastUpdateDate: | 11/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | 209.006636 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult | 364SP0808X | 99997 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
No ID Information.