Provider Demographics
NPI:1841617529
Name:BOOHER, CHIP (FNP)
Entity Type:Individual
Prefix:MR
First Name:CHIP
Middle Name:
Last Name:BOOHER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3013
Mailing Address - Country:US
Mailing Address - Phone:760-482-0864
Mailing Address - Fax:760-482-9185
Practice Address - Street 1:120 W COLE BLVD STE B
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-9700
Practice Address - Country:US
Practice Address - Phone:760-890-0190
Practice Address - Fax:760-890-0160
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426570163W00000X
CA95000248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse