| Doctor Name: | JOAN O BOVARD |
| NPI Number: | 1053715516 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN FNP-BC |
| License Number: | COA.16659-NP |
| Business Practice Address: | 525 Alexandria Pike Suite 300 Southgate, KY - 410713247 |
| Business Phone Number: | 8597812210 |
| Business Fax Number: | 8597810289 |
| Mailing Address: | 2300 Chamber Center Dr, Suite 200 LAKESIDE PARK |
| State: | KY |
| Postal Code: | 410171686 |
| Phone Number: | 8497812210 |
| Fax Number: | 8597810289 |
| NPI Enumeration Date: | 10/13/2014 |
| NPI Last Update Date: | 11/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | COA.16659-NP |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |