Active NPI
Ashley Lannen Booth, HSP-PA
- Psychologist
- Fairmont, NC
National Provider Identifier
1699840165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 0803
- Practice address
- 302 N Main St
Fairmont, NC 28340-1730 - Phone
- (910) 628-6718
- Fax
- (910) 628-6719
- NPI assigned
- Nov 21, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 0803 | NC | Primary |
Addresses
Primary practice location
302 N Main St
Fairmont, NC 28340-1730
Mailing address
PO Box 369
Fairmont, NC 28340-0369
Phone (910) 628-6718
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6107276 | Medicaid | NC |
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 |
|---|---|---|---|
| 0803 | NC | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699840165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 369",
"city": "FAIRMONT",
"state": "NC",
"postal_code": "283400369",
"telephone_number": "910-628-6718",
"fax_number": "910-628-6719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 N MAIN ST",
"city": "FAIRMONT",
"state": "NC",
"postal_code": "283401730",
"telephone_number": "910-628-6718",
"fax_number": "910-628-6719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "ASHLEY",
"middle_name": "LANNEN",
"credential": "HSP-PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "0803",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6107276",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, NC
- Saqib Aziz, M.D.
- Eulalia Cidela Barajas-Graham, PA
- Bio-Medical Applications of North Carolina, Inc. (FMC Dialysis Services of Robeson County)
- Karen R. Bissell, M.D.
- Jane A Blackwell, PHARMD
- Ben Brady, RPH
- Bradys Pharmacy Inc (Websters Pharmacy)
- Natural Morgan Breeden, LCSWA
- Mary Alexis Britt
- Olivia Naomie Bullard
Sources for this page
- 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.