MEDICARE: BROOKE DENISE BOOHER APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F06200392	TN
2	363LF0000X	Family Nurse Practitioner	27712	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14677662	OTHER		CAQH

General Provider Information

NPI Number	:	1306462478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE DENISE BOOHER APRN, FNP-C

Provider Business Mailing Address
First Line	:	611 BELL RD SE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-9003
Country	:	US
Telephone Number	:	423-728-4020
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 BELL RD SE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-9003
Country	:	US
Telephone Number	:	423-715-0897
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	06/24/2020

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