Organization
DERMATOLOGY ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA CRAIG BOOHER NURSE PRACTITIONER (OWNER)
(731) 661-0061
Entity
Organization
Contact information
Practice address
2817 N HIGHLAND AVE, SUITE A, JACKSON, TN 38305-1789
(731) 661-0061
(731) 661-9107
Mailing address
2817 N HIGHLAND AVE, SUITE A, JACKSON, TN 38305-1789
(731) 661-0061
(731) 661-9107
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APN 000 000 8039
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3370114
—
TN
01
—
4165097
BLUE CROSS BLUE SHIELD
TN
01
—
7587201
AETNA
—
Enumeration date
05/22/2007
Last updated
03/04/2008
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