Active NPI
Kelly Jo Boyer, NP
- Nurse Practitioner
- Elkhart, IN
National Provider Identifier
1962462689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71001272A
- Practice address
- 1004 Parkway Ave
Suite C
Elkhart, IN 46516-9326 - Phone
- (574) 294-1883
- Fax
- (574) 295-1749
- NPI assigned
- Mar 25, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71001272A | IN | Primary |
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
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200313030 | Medicaid | IN |
Medicare participation
Medicare enrollment files- 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
- Opted out of Medicare
- Yes, effective Jan 1, 2018 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71001272A | IN | MD | Nurse Practitioner |
NPI Registry JSON
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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200313030",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- 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.