Kelly Jo Boyer, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71001272A Issued in IN

Practice address

1004 Parkway Ave
Suite C
Elkhart, IN 46516-9326

Phone

(574) 294-1883

Fax

(574) 295-1749

NPI assigned

Mar 25, 2006

Last updated

Feb 12, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2018 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Crossroads Healing Arts, LLC

  • Family Medicine Physician
  • Elkhart, IN
  • NPI 1295028694
  Authorized official Same address or phone

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

{
    "created_epoch": "1143244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423699200000",
    "number": "1962462689",
    "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": {
        "last_name": "BOYER",
        "first_name": "KELLY",
        "middle_name": "JO",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-25",
        "last_updated": "2015-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71001272A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Boughton
• Mariem Boussaha
• Jacque Arlin Boutwell Jr., CFA
• Cheyenne Bowe
• Alexis Rae Bowman, MD
• Lauren Boyle, LCSW
• Kimberly Ann Boynton, MS CCC-SLP
• Joni Lee Bradberry
• Erin Anne Brandes, FNP-BC
• Cheryl Brandt, R.D., C.D.

• Nurse Practitioner in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.