Individual provider Active NPI

Yasmin Renee Boothe

  • Licensed Practical Nurse
  • Rochester, NY
National Provider Identifier
1104720481
Registry record updated Oct 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
350992 Issued in NY
Practice address
111 Dove St
Rochester, NY 14613-1315
Phone
(585) 703-3881
NPI assigned
Oct 8, 2026
Last updated
Oct 8, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 350992 NY Primary

Addresses

Primary practice location

111 Dove St
Rochester, NY 14613-1315

Mailing address

111 Dove St
Rochester, NY 14613-1315
Phone (585) 703-3881

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

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

{
    "created_epoch": "1791417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791417600000",
    "number": "1104720481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 DOVE ST",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146131315",
            "telephone_number": "585-703-3881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DOVE ST",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146131315",
            "telephone_number": "585-703-3881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTHE",
        "first_name": "YASMIN",
        "middle_name": "RENEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-10-08",
        "last_updated": "2026-10-08",
        "certification_date": "2026-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "350992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.