Provider Demographics
NPI:1588642672
Name:BOOTH, KATHRYN G (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:G
Last Name:BOOTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5739
Mailing Address - Country:US
Mailing Address - Phone:207-623-1322
Mailing Address - Fax:
Practice Address - Street 1:5 CALDWELL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5739
Practice Address - Country:US
Practice Address - Phone:207-623-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER024245363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000975OtherANTHEM
ME287710099Medicaid
MED03548OtherHARVARD PILGRAM
ME1041748OtherAETNA
ME0449265OtherCIGNA
ME287710099Medicaid