Thaddeus Jason Boughton ANP-BC

NPI 1043553357 - Nurse Practitioner - 363LA2200X

NPI Details
NPI 1043553357
Gender Male
Enumeration Date 04/04/2013
Last Updated 05/22/2013
Entity Type Individual
Active Over 4 years ago
Practice Location
1369A GEORGE WALLACE HWY
RUSSELLVILLE AL, 35654-3281, US
Phone (256) 331-2615
Fax
Business Location
309 FULTON ST
MUSCLE SHOALS AL, 35661-3669, US
Phone (256) 856-4059
Fax
Toxanomy
Taxonomy Code 363LA2200X
License State Alabama
License Number 1139488
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According to our database, Mr. Thaddeus Jason Boughton ANP-BC NPI is 1043553357, taxonomy code is 363LA2200X and license number is 1139488, license state is located at Alabama. Thaddeus Jason Boughton ANP-BC physically located at 1369a George Wallace Hwy, Russellville AL, 35654-3281. NPI Number Thaddeus Jason Boughton ANP-BC has the Individual type.

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1043553357 NPI number is provided on an as is basis without warranty of any kind. 1043553357 is maintained by the National Plan & Provider Enumeration System. The contents of Thaddeus Jason Boughton ANP-BC are for informational purposes only.