NPIMap

Crossroads Healing Arts, LLC

Organization Active NPI Family Medicine Physician · Elkhart, IN

NPI 1295028694 · NPPES record last updated Feb 12, 2015

Key facts

NPI
1295028694
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
License
1067015A (IN)
Legal business name
CROSSROADS HEALING ARTS, LLC
Practice address
1004 Parkway Ave
Suite C
Elkhart, IN 46516-9326
Phone
(574) 294-1883
Fax
(574) 295-1749
NPI assigned
May 18, 2011
Organization subpart
No

Authorized official

Name
Ms. Kelly J Boyer, WHCNP
Title
Nurse Practitioner/Owner
Phone
(574) 294-1883

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Locations

56218 Parkway Ave
Ste C
Elkhart, IN 46516

1004 Parkway Ave
Ste C
Elkhart, IN 46516
Phone (574) 294-1883

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X 1067015A IN Yes
Preventive Medicine/Occupational Environmental Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2083P0500X 02002929A IN
Women's Health Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363LW0102X 71001272 IN

Addresses

Primary practice location

1004 Parkway Ave
Suite C
Elkhart, IN 46516-9326

Mailing address

1004 Parkway Ave
Suite C
Elkhart, IN 46516-9326
Phone (574) 294-1883

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 12, 2015.

{
    "created_epoch": "1305676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423699200000",
    "number": "1295028694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 PARKWAY AVE",
            "address_2": "SUITE C",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465169326",
            "telephone_number": "574-294-1883",
            "fax_number": "574-295-1749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 PARKWAY AVE",
            "address_2": "SUITE C",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465169326",
            "telephone_number": "574-294-1883",
            "fax_number": "574-295-1749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS HEALING ARTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-18",
        "last_updated": "2015-02-12",
        "status": "A",
        "authorized_official_last_name": "BOYER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "574-294-1883",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "WHCNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "1067015A",
            "primary": true
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "IN",
            "license": "02002929A",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "IN",
            "license": "71001272",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

All providers in Elkhart, IN · Family Medicine Physician in Indiana

Sources for this page

Verify at the official NPI Registry.