J Boatman LLC

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

11805 Issued in MO

Legal business name

J BOATMAN LLC

Practice address

11475 Olde Cabin Rd Ste 120
Creve Coeur, MO 63141-7128

Phone

(314) 647-4488

Fax

(314) 647-6305

NPI assigned

Feb 1, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeffrey Boatman, MSNNPI 1265570592

Title

Owner

Phone

(314) 753-5184

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey E Boatman, MSN, RN

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • Saint Louis, MO
  • NPI 1265570592
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665360000000",
    "number": "1003112558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5807 MANGO DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631292243",
            "telephone_number": "314-753-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11475 OLDE CABIN RD STE 120",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417128",
            "telephone_number": "314-647-4488",
            "fax_number": "314-647-6305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 Bellevue Ave",
            "address_purpose": "LOCATION",
            "city": "St Louis",
            "state": "MO",
            "postal_code": "63117",
            "country_code": "US",
            "telephone_number": "314-647-4788",
            "fax_number": "314-647-6305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "J BOATMAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-01",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A",
        "authorized_official_last_name": "BOATMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-753-5184",
        "authorized_official_credential": "MSN"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MO",
            "license": "11805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "580714",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Psychiatric/Mental Health Registered Nurse in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Adult Psychiatric/Mental Health Registered Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.