Active NPI
Juanita Gail Boughers
- Attendant Care Provider
- Belle Rive, IL
National Provider Identifier
1124753041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Attendant Care Provider
- Practice address
- 405 S Main St
Belle Rive, IL 62810-1228 - Phone
- (618) 316-1626
- NPI assigned
- Jul 24, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | Primary |
Addresses
Primary practice location
405 S Main St
Belle Rive, IL 62810-1228
Mailing address
1026 N 7TH St
Mount Vernon, IL 62864-3334
Phone (618) 417-2536
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658620800000",
"number": "1124753041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1026 N 7TH ST",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628643334",
"telephone_number": "618-417-2536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 S MAIN ST",
"city": "BELLE RIVE",
"state": "IL",
"postal_code": "628101228",
"telephone_number": "618-316-1626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUGHERS",
"first_name": "JUANITA",
"middle_name": "GAIL",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-24",
"last_updated": "2022-07-24",
"certification_date": "2022-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "3747A0650X",
"taxonomy_group": "",
"desc": "Technician, Attendant Care Provider",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belle Rive, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.