Active NPI
Bridget Kathleen Booth, PHD PMHCNS-BC
- Adult Psychiatric/Mental Health Clinical Nurse Specialist
- Fayetteville, NC
National Provider Identifier
1043242852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Psychiatric/Mental Health Clinical Nurse Specialist
- License
- 193660
- Practice address
- 2300 Ramsey St
VA Medical Center
Fayetteville, NC 28301 - Phone
- (910) 488-2120
- Fax
- (910) 822-7017
- NPI assigned
- Jul 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C004317 | NC | |
| Adult Psychiatric/Mental Health Clinical Nurse Specialist | 364SP0809X | 193660 | NC | Primary |
Addresses
Primary practice location
2300 Ramsey St
VA Medical Center
Fayetteville, NC 28301
Mailing address
96 Rogers Rd
Lillington, NC 27546-7305
Phone (910) 580-4856
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BO261381 | Other | PA | BLUE CROSS BLUE SHIELD |
| IP156708 | Other | PA | MAGELLAN BEHAVIORAL HEALT |
Other names 1
- Dr. Bridget Kathleen Booth
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C004317 | NC | MD | Clinical Social Worker |
| 193660 | NC | MD | Adult Psychiatric/Mental Health Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213056000000",
"number": "1043242852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "96 ROGERS RD",
"city": "LILLINGTON",
"state": "NC",
"postal_code": "275467305",
"telephone_number": "910-580-4856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 RAMSEY ST",
"address_2": "VA MEDICAL CENTER",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "28301",
"telephone_number": "910-488-2120",
"fax_number": "910-822-7017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "BRIDGET",
"middle_name": "KATHLEEN",
"name_prefix": "Dr.",
"credential": "PHD PMHCNS-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-06",
"last_updated": "2008-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C004317",
"primary": false
},
{
"code": "364SP0809X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
"state": "NC",
"license": "193660",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "BO261381",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN BEHAVIORAL HEALT",
"identifier": "IP156708",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "BRIDGET",
"last_name": "BOOTH",
"middle_name": "KATHLEEN",
"prefix": "DR.",
"credential": "PHD LCSW",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.