NPIMap

Individual provider Active NPI

Connie Renee Boehman, FNP-C

  • Family Nurse Practitioner
  • Evansville, IN
National Provider Identifier
1679931778
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201318 Issued in ND
Practice address
610 E Walnut St Ste a
Evansville, IN 47713-2460
Phone
(844) 999-9019
NPI assigned
Feb 3, 2016
Last updated
Jan 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3010041 KY
Family Nurse Practitioner 363LF0000X 71006571A IN
Family Nurse Practitioner 363LF0000X 201318 ND Primary

Addresses

Primary practice location

610 E Walnut St Ste a
Evansville, IN 47713-2460

Mailing address

3923 Cross Creek TRL
Owensboro, KY 42303-1895
Phone (812) 719-9414

Other practice location 1

1701 38th St S Ste 101
Fargo, ND 58103-4499
Phone (701) 356-1500

Other names 1

  • Mrs. Connie Renee Kiesling Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160412002583 KY Practitioner - Nurse Practitioner 5597839712 Reassigns benefits to 2 organizations
I20250306001648 MN Practitioner - Nurse Practitioner 5597839712

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern Kentucky Vascular Clinic PLLCGroup PAC ID 6901289628, 7 clinicians

Practice addresses (Care Compare)

50 Medpark Square Dr
Suite 3
Somerset, KY 42503-1708
Phone (606) 531-4100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3010041KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Heart to Heart Hospice of Evansville, LLC CurrentSince Oct 27, 2024 Accepting new patients
Southern Kentucky Vascular Clinic PLLC Family CurrentSince Jan 18, 2026 Accepting new patients
Community Carepartners, Inc. Family Past Accepting new patients
Hospice of the Red River Valley Past Accepting new patients
Rural Health Group, Inc. Past Accepting new patients
Southern Kentucky Vascular Procedure Center, PLLC PastSince Jul 1, 2022 Accepting new patients
Ronald E Hughes Past Accepting new patients

Locations

610 E Walnut St
Evansville, IN 47713
Phone (812) 425-3561

610 E Walnut St
Ste A
Evansville, IN 47713
Phone (812) 549-0373

25 Medpark Dr
Ste 3
Somerset, KY 42503

50 Medpark Dr
Ste 3
Somerset, KY 42503

7240 Chase Oaks Blvd
Plano, TX 75025
Phone (972) 517-6300

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FEIHCD

Organizations & group practices 8

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

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1454457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1679931778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3923 CROSS CREEK TRL",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423031895",
            "telephone_number": "812-719-9414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 E WALNUT ST STE A",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477132460",
            "telephone_number": "844-999-9019"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1701 38th St S Ste 101",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581034499",
            "country_code": "US",
            "telephone_number": "701-356-1500",
            "fax_number": "701-356-1596",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOEHMAN",
        "first_name": "CONNIE",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-03",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3010041",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71006571A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "201318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CONNIE",
            "last_name": "KIESLING",
            "middle_name": "RENEE",
            "prefix": "MRS.",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.