Provider Demographics
NPI:1215310784
Name:BOONE, MICHELLE (DNP, APRN)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-0509
Mailing Address - Country:US
Mailing Address - Phone:870-845-1933
Mailing Address - Fax:866-616-2448
Practice Address - Street 1:1400 LESLIE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-4027
Practice Address - Country:US
Practice Address - Phone:870-845-1933
Practice Address - Fax:866-616-2448
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004771363LA2100X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health