Active NPI
Jennifer Boyd Bootle, FNP
- Family Nurse Practitioner
- Savannah, GA
National Provider Identifier
1417296898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN227783
- Practice address
- 14089 Abercorn St
Savannah, GA 31419-1966 - Phone
- (912) 350-2121
- Fax
- (912) 350-2145
- NPI assigned
- Feb 5, 2013
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN227783 | GA | Primary |
| Family Nurse Practitioner | 363LF0000X | 18172 | SC |
Addresses
Primary practice location
14089 Abercorn St
Savannah, GA 31419-1966
Mailing address
14089 Abercorn St
Savannah, GA 31419-1966
Phone (912) 350-2121
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003138354B | Medicaid | GA | |
| 003138354A | Medicaid | GA | |
| P01241129 | Other | GA | RAILROAD MEDICARE |
| 003138354C | Medicaid | GA | |
| 003138354D | Medicaid | GA |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN227783 | GA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414972800000",
"number": "1417296898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14089 ABERCORN ST",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314191966",
"telephone_number": "912-350-2121",
"fax_number": "912-350-2145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14089 ABERCORN ST",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314191966",
"telephone_number": "912-350-2121",
"fax_number": "912-350-2145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTLE",
"first_name": "JENNIFER",
"middle_name": "BOYD",
"name_prefix": "Mrs.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-05",
"last_updated": "2014-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN227783",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "SC",
"license": "18172",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003138354B",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003138354A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P01241129",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003138354C",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003138354D",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.