Kenneth J Boone Sr., MD - INTERN

Primary specialty

CounselorTaxonomy code 101Y00000X

License

CI5343 Issued in NV

Practice address

1703 Civic Center Dr Ste 5
North Las Vegas, NV 89030-7273

Phone

(716) 308-0228

NPI assigned

Nov 6, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vitalrise Behavioral Health, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Las Vegas, NV
  • NPI 1710816681
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1699228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1679346290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 S EASTERN AVE., STE. 6",
            "address_2": "UNIT 126",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89119",
            "telephone_number": "716-308-0228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 CIVIC CENTER DR STE 5",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890307273",
            "telephone_number": "716-308-0228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4580 S Eastern Ave Ste 33",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891196100",
            "country_code": "US",
            "telephone_number": "716-308-0228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOONE",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_suffix": "Sr.",
        "credential": "MD - INTERN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-06",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NV",
            "license": "CI5343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aja Bonner
• Courtney Bonner
• Lauren Kay Bonner, BA
• Misty Booker
• Kenneth C. Boone
• Terrenc M Booth
• Mary Borja, PT
• Melchor V Borja, PT
• Ruby Borja, NP-C
• Leonel Borjon, PA-C

• Counselor in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Counselor in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.