Kathleen Marie Booth, RNC, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R1226809 Issued in MN

Practice address

2115 Summit Ave
Student Health Services # 5056
St Paul, MN 55105

Phone

(651) 962-6750

Fax

(651) 962-6751

NPI assigned

Mar 6, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Student Health Service University of St. Thomas

  • Student Health Clinic/Center
  • Saint Paul, MN
  • NPI 1881819886
  NPD (past)

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114057510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 RED PINE RD",
            "city": "NORTH OAKS",
            "state": "MN",
            "postal_code": "551272030",
            "telephone_number": "651-490-7863",
            "fax_number": "651-490-7863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 SUMMIT AVE",
            "address_2": "STUDENT HEALTH SERVICES # 5056",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55105",
            "telephone_number": "651-962-6750",
            "fax_number": "651-962-6751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "KATHLEEN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "RNC, NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R1226809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roberta Lee Bonrud, RRT
• Elizabeth Bonson, M.D.
• Jenna Booher
• Irving Boone, PH.D
• Grant Edward Booth, MSW, LICSW, ACSW
• Carrie M Borchardt, MD
• Troy Borchardt, LPCC
• Kathleen Mae Borchert, RN, CWOCN, ACNS-BC
• Liliana G Bordeianou, M.D.
• Amy Rebecca Borden, D.O.

• Family Nurse Practitioner in St Paul, MN
• Providers in St Paul, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.