Individual
KATHY L BOOTHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
54 ATLANTIC PL, BEACON HOSPICE/AMEDISYS, SOUTH PORTLAND, ME 04106-2316
(207) 772-0929
Mailing address
54 ATLANTIC PL, BEACON HOSPICE/AMEDISYS, SOUTH PORTLAND, ME 04106-2316
(207) 772-0929
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
036390-23
NH
363LA2200X
Adult Health Nurse Practitioner
Primary
CNP81113
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427032432
BCBS
MA
05
—
30343033
—
NH
01
—
40Y007193NH01
ANTHEM
—
Enumeration date
12/02/2005
Last updated
02/27/2017
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