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General NPI Number Information
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NPI Number | 1750590923
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES LLC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 2817 N HIGHLAND AVE SUITE A
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City | JACKSON
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State | TN
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Zip | 38305-1789
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Country | US
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Telephone | 731-661-0061
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Fax | 731-661-9107
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Provider Business Mailing Address
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Address Line | 2817 N HIGHLAND AVE SUITE A
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City | JACKSON
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State | TN
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Zip | 38305-1789
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Country | US
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Telephone | 731-661-0061
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Fax | 731-661-9107
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Authorized Official
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Title or Position | OWNER
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Name | MS. PATRICIA CRAIG BOOHER
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Credential | NURSE PRACTITIONER
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Telephone | 731-661-0061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN 000 000 8039
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License Number State | TN
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