Provider Demographics
NPI:1417963570
Name:BOOHER, PATRICIA CRAIG (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:CRAIG
Last Name:BOOHER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE
Mailing Address - Street 1:701 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-3034
Mailing Address - Country:US
Mailing Address - Phone:731-784-4300
Mailing Address - Fax:731-784-4308
Practice Address - Street 1:701 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-3034
Practice Address - Country:US
Practice Address - Phone:731-784-4300
Practice Address - Fax:731-784-4308
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000127326163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4165097OtherBLUE CROSS BLUE SHIELD
TN3908364Medicaid
7587201OtherAETNA
2427722OtherCIGNA
TN3908364Medicaid
TN3908364Medicare PIN