Provider Demographics
NPI:1912487703
Name:BOOTH, JAMIE (RN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:GRADY
Mailing Address - State:NM
Mailing Address - Zip Code:88120-0071
Mailing Address - Country:US
Mailing Address - Phone:575-357-2192
Mailing Address - Fax:
Practice Address - Street 1:100 FRANKLIN ST.
Practice Address - Street 2:
Practice Address - City:GRADY
Practice Address - State:NM
Practice Address - Zip Code:88120
Practice Address - Country:US
Practice Address - Phone:575-357-2192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-79918163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool