Active NPI
Judith Ann Booth, LMP
- Other Technician
- Mount Vernon, WA
National Provider Identifier
1497025118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- MA 60262828
- Practice address
- 17226 Memorial Highway
Mount Vernon, WA 98273 - Phone
- (360) 610-3279
- NPI assigned
- Jan 11, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | MA 60262828 | WA | Primary |
Addresses
Primary practice location
17226 Memorial Highway
Mount Vernon, WA 98273
Mailing address
18304 Capet Zalsiluce Rd
La Conner, WA 98257-9334
Phone (360) 610-3279
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 60262828 | WA | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326240000000",
"number": "1497025118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18304 CAPET ZALSILUCE RD",
"city": "LA CONNER",
"state": "WA",
"postal_code": "982579334",
"telephone_number": "360-610-3279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17226 MEMORIAL HIGHWAY",
"city": "MOUNT VERNON",
"state": "WA",
"postal_code": "98273",
"telephone_number": "360-610-3279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "JUDITH",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-01-11",
"last_updated": "2012-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "WA",
"license": "MA 60262828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.