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NPI Code Detail

MEDICARE: MRS. JUDITH ANN BOOTH

MEDICARE: MRS. JUDITH ANN BOOTH
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1740315803
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JUDITH ANN BOOTH
Provider Business Mailing Address
First Line : PO BOX 251970
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72225-1970
Country : US
Telephone Number : 501-666-8686
Fax Number : 501-660-6830
Provider Business Practice Location Address
First Line : 5905 FOREST PL
Second Line : SUITE 100
City : LITTLE ROCK
State : AR
Zip : 72207-5244
Country : US
Telephone Number : 501-666-4949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 07/08/2007

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