Provider Demographics
NPI:1699073916
Name:BOYNTON, ELLEN M (PA-C)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:BOYNTON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:M
Other - Last Name:MCGUIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 874797
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-4797
Mailing Address - Country:US
Mailing Address - Phone:314-849-8700
Mailing Address - Fax:
Practice Address - Street 1:9701 LANDMARK PARKWAY DR STE 207
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1665
Practice Address - Country:US
Practice Address - Phone:314-849-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52534363A00000X
MO20240478142363A00000X
IL085004009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant