Individual
ELIJAH BOOTHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
499 OLD COLUMBIA RD, HARRISONBURG, LA 71340-3001
(318) 744-2121
Mailing address
192 BASTILLE LN, SUITE 200, RUSTON, LA 71270-7149
(318) 475-0779
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN132128
LA
363LF0000X
Family Nurse Practitioner
Primary
AP07815
LA
Other
Enumeration date
03/23/2016
Last updated
03/23/2016
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