Provider Demographics
NPI:1427032432
Name:BOOTHBY, KATHY L (APRN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:BOOTHBY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ATLANTIC PL
Mailing Address - Street 2:BEACON HOSPICE/AMEDISYS
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-772-0929
Mailing Address - Fax:
Practice Address - Street 1:54 ATLANTIC PL
Practice Address - Street 2:BEACON HOSPICE/AMEDISYS
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2316
Practice Address - Country:US
Practice Address - Phone:207-772-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH036390-23363LA2200X
MECNP81113363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30343033Medicaid
MA1427032432OtherBCBS
40Y007193NH01OtherANTHEM
NH30343033Medicaid
NHNP3963Medicare PIN
40Y007193NH01OtherANTHEM