Individual
DEREK BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 N 26TH ST, SUITE 201, LAFAYETTE, IN 47904-2895
(765) 446-6577
Mailing address
415 N 26TH ST, SUITE 201, LAFAYETTE, IN 47904-2895
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71005314B
IN
Other
Enumeration date
01/24/2015
Last updated
01/24/2015
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