Provider Demographics
NPI:1336612472
Name:BOUGHTER, BILLIE JO (CRNP)
Entity Type:Individual
Prefix:DR
First Name:BILLIE JO
Middle Name:
Last Name:BOUGHTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 SILVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3307
Mailing Address - Country:US
Mailing Address - Phone:302-478-8889
Mailing Address - Fax:302-478-1321
Practice Address - Street 1:3322 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3307
Practice Address - Country:US
Practice Address - Phone:302-478-8889
Practice Address - Fax:302-478-1321
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0000286363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner