Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 40489 | KY |
N | 207VG0400X | Gynecologist | 35084722 | OH |
N | 207VX0000X | Obstetrician | 35084722 | OH |
NPI | 1447216023 |
---|---|
Provider Name | Dr. Stacy Boulton |
First Address | Florence, KY 41042-1618 |
Second Address | Florence, KY 41042-1618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 26/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2494840 | (05) | OH |
I09794 | (02) | KY |