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NPI Code Detail

MEDICARE: MS. LISA DAWN BOOTH F.N.P.

MEDICARE: MS. LISA DAWN BOOTH F.N.P.
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
1363LF0000XFamily Nurse Practitioner19109TN

General Provider Information

NPI Number : 1306248182
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA DAWN BOOTH F.N.P.
Provider Business Mailing Address
First Line : PO BOX 400
Second Line :
City : JACKSON
State : TN
Zip : 38302-0400
Country : US
Telephone Number : 731-422-0213
Fax Number : 731-660-8369
Provider Business Practice Location Address
First Line : 145 INNOVATION DR
Second Line :
City : JACKSON
State : TN
Zip : 38305-3019
Country : US
Telephone Number : 731-422-0213
Fax Number : 731-422-0475
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2014
Last Update Date : 03/28/2024

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