Dermatology Associates LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APN 000 000 8039 Issued in TN

Legal business name

DERMATOLOGY ASSOCIATES LLC

Practice address

2817 N Highland Ave
Suite a
Jackson, TN 38305-1789

Phone

(731) 661-0061

Fax

(731) 661-9107

NPI assigned

May 22, 2007

Last updated

Mar 4, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Patricia Craig Booher, NURSE PRACTITIONER

Title

Owner

Phone

(731) 661-0061

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1750590923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 N HIGHLAND AVE",
            "address_2": "SUITE A",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051789",
            "telephone_number": "731-661-0061",
            "fax_number": "731-661-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 N HIGHLAND AVE",
            "address_2": "SUITE A",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051789",
            "telephone_number": "731-661-0061",
            "fax_number": "731-661-9107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "BOOHER",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-661-0061",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "APN 000 000 8039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4165097",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7587201",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3370114",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Delta Home Access LLC
• Kaylee Ann Demar, SLP
• Melissa B Dennison, PHARMACIST
• Dental Associates Inc
• Karen E Depriest, PHARM D
• Dermatology Clinic of Jackson
• Paul Deschenes, PSY.D.
• Detox West Tennessee LLC (Brentwood Springs Detox)
• Terry M Devall, DMD
• Lindy Deweese, PHARMD

• Nurse Practitioner in Jackson, TN
• Providers in Jackson, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; 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.