Angela Boose, APRN-PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Dyer, IN
NPI 1194329458 · NPPES record last updated Jan 13, 2025
Key facts
- NPI
- 1194329458
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 71016038A (IN)
- Practice address
- 24 Joliet St
Dyer, IN 46311-1705 - Phone
- (219) 322-5747
- Fax
- (219) 864-2282
- NPI assigned
- Nov 27, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Franciscan Physician Network
Practice addresses (Care Compare)
24 Joliet St
Dyer, IN 46311-1705
Phone (219) 864-2059
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241214000194 | IN | Practitioner - Nurse Practitioner | 9931635836 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28231278A | IN | MD | Registered Nurse |
| 71016038A | IN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Franciscan Physician Network | Current |
Accepting new patients | |
| Franciscan Physician Network | Current |
Accepting new patients | |
| Southlake Community Mental Health Center Inc. | Past |
Accepting new patients |
Locations
1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120
24 Joliet St
Dyer, IN 46311
Phone (219) 864-2237
720 45th St
Munster, IN 46321
Phone (219) 852-2513
150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28231278A | IN | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 71016038A | IN | Yes |
Addresses
Primary practice location
24 Joliet St
Dyer, IN 46311-1705
Mailing address
PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800
Other practice location 1
2600 Highway Ave
Highland, IN 46322-1613
Phone (219) 972-0131
Other providers in Dyer, IN
- Kidanu Birhanu
- Lara Marie Blanchard
- Christina Blazo
- Christina Bocken
- Mohen Bohjwani
- James A Borgetti
- Alyssa Marie Borkowski
- Valerie Boromisa
- Jessica Bosques
- Melissa Dawn Bourland
All providers in Dyer, IN · Psychiatric/Mental Health Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.