Healthcare Provider Details

I. General information

NPI: 1871933929
Provider Name (Legal Business Name): KATRINA M BOOZE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 LEXINGTON AVE
SPRINGFIELD OH
45505-2620
US

IV. Provider business mailing address

2624 LEXINGTON AVE
SPRINGFIELD OH
45505-2620
US

V. Phone/Fax

Practice location:
  • Phone: 937-328-5300
  • Fax:
Mailing address:
  • Phone: 937-328-5300
  • Fax: 937-322-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberRN353747
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0037800
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: