Provider Demographics
NPI:1053715516
Name:BOVARD, JOAN O (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:O
Last Name:BOVARD
Suffix:
Gender:F
Credentials:APRN FNP-BC
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:849-212-5478
Mailing Address - Fax:859-212-5037
Practice Address - Street 1:525 ALEXANDRIA PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071
Practice Address - Country:US
Practice Address - Phone:859-781-2210
Practice Address - Fax:859-781-0289
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16659-NP363LF0000X
KY3009017363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100339070Medicaid
KYK191790Medicare PIN