Provider Demographics
NPI:1003989351
Name:BOOTEN, CYNTHIA J (FNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:BOOTEN
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:436 CLAIRMONT CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1765
Mailing Address - Country:US
Mailing Address - Phone:804-526-2121
Mailing Address - Fax:804-520-2617
Practice Address - Street 1:436 CLAIRMONT CT
Practice Address - Street 2:SUITE 100
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1765
Practice Address - Country:US
Practice Address - Phone:804-526-2121
Practice Address - Fax:804-520-2617
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA007138155207Q00000X
VA0024166276363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1003989351OtherNPI
11657718OtherCAQH