Melissa Susan Boothroyd, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

4704121618 Issued in MI

Practice address

23200 Ryan Rd
Fitzgerald Health Center
Warren, MI 48091-4551

Phone

(586) 759-9070

NPI assigned

Oct 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649356551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29085 OAK POINT DR",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483312715",
            "telephone_number": "248-489-8632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23200 RYAN RD",
            "address_2": "FITZGERALD HEALTH CENTER",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480914551",
            "telephone_number": "586-759-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTHROYD",
        "first_name": "MELISSA",
        "middle_name": "SUSAN",
        "name_prefix": "Ms.",
        "credential": "PNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704121618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4667898",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Bormans Inc (Farmer Jack Pharmacy)
• Tynikia Bostic, PMHNP-BC
• Cutise Dorion-Mae Boswell, LLMSW

• Pediatric Nurse Practitioner in Warren, MI
• Providers in Warren, MI by specialty
• Pediatric Nurse Practitioner in Michigan

• 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.