Active NPI
Dynisha S Boom
- Adult Companion
- Tallahassee, FL
National Provider Identifier
1497212781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- License
- 235416
- Practice address
- 2000 N Meridian Rd Apt 265
Tallahassee, FL 32303-4950 - Phone
- (850) 519-1294
- NPI assigned
- Feb 22, 2019
- 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 |
|---|---|---|---|---|
| Homemaker | 376J00000X | 235416 | FL | |
| Adult Companion | 372600000X | 235416 | FL | Primary |
Addresses
Primary practice location
2000 N Meridian Rd Apt 265
Tallahassee, FL 32303-4950
Mailing address
2000 N Meridian Rd Apt 265
Tallahassee, FL 32303-4950
Phone (850) 519-1294
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 |
|---|---|---|---|
| 235416 | FL | MD | Homemaker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550793600000",
"number": "1497212781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 N MERIDIAN RD APT 265",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323034950",
"telephone_number": "850-519-1294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 N MERIDIAN RD APT 265",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323034950",
"telephone_number": "850-519-1294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOM",
"first_name": "DYNISHA",
"middle_name": "S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-22",
"last_updated": "2019-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": "FL",
"license": "235416",
"primary": false
},
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": "FL",
"license": "235416",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tallahassee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.