Provider Demographics
NPI:1972581262
Name:BOOKER, MARY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:MARY LYNN
Middle Name:
Last Name:BOOKER
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 1:11814 KING WILLIAM RD
Mailing Address - Street 2:PO BOX 213
Mailing Address - City:AYLETT
Mailing Address - State:VA
Mailing Address - Zip Code:23009-4103
Mailing Address - Country:US
Mailing Address - Phone:804-769-3022
Mailing Address - Fax:804-769-1253
Practice Address - Street 1:11814 KING WILLIAM RD
Practice Address - Street 2:
Practice Address - City:AYLETT
Practice Address - State:VA
Practice Address - Zip Code:23009-4103
Practice Address - Country:US
Practice Address - Phone:804-769-3022
Practice Address - Fax:804-769-1253
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024138177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily