Community Practitioner Program
Dashboard
date-266
2021-08-24
Professional
Physician Asstistant
PracticeName
Boone-Health
MonthYearStartedPracticingCurrentSite
2021-08-01
PracticeCity
Boone
Practice
28433
OfficePhone
9106125782
HomeAddress
7440 Bright Leaf Rd.
HomeState
nc
HomeCounty
bpopne
NCMedicalBoardLicenseNumber
12352-23456
checkbox-589
No
checkbox-924
No
textarea-514
PercentageofPractice
12
practicebusinessmanager
Yolanda Yetty
EmailAddress
yy@gmail.com
practitionerssalary
120,000
Signature
Joseph Miles
file-233
Sequence Number
your-name
Joseph Miles
Type
Primary Care
MonthYearStartedPracticing
2021-08-04
PracticeAddress
7440 Bright Leaf Rd.
PracticeState
NC
PracticeCounty
boone
HomePhone
9106125782
HomeCity
boone
HomeZip
28411
your-email
boon@gmail.com
checkbox-900
No
PracticesManagementStructureandPrincipalOwners
Listallprovidersandtheirprofessionalstatus
checkbox-864
No,No,No,No,Yes,Yes,Yes,No,No,No,No,No,Yes,Yes,Yes,Yes
NumberofPatients
1235
ContactNumber
555-555-5555
languagesspoken
french
Loanamount
10,000
date-533
2021-08-24
Entry ID
2021/08/24 at 2:19 pm