Healthcare Provider Details

I. General information

NPI: 1841634946
Provider Name (Legal Business Name): EMILY BOOTHE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2013
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 SOUTHVIEW DR
BLUEFIELD WV
24701-4317
US

IV. Provider business mailing address

1333 SOUTHVIEW DR
BLUEFIELD WV
24701-4317
US

V. Phone/Fax

Practice location:
  • Phone: 304-327-9205
  • Fax:
Mailing address:
  • Phone: 304-327-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number3196
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: