Active NPI
Maquia Massirie Hall-Booth, LPN
- Child Physical Disabilities Respite Care
- Clarksville, TN
National Provider Identifier
1871050104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child Physical Disabilities Respite Care
- License
- 0219037
- Practice address
- 3129 Westchester Dr
Clarksville, TN 37043-3804 - Phone
- (708) 359-5472
- NPI assigned
- Feb 22, 2019
- 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 |
|---|---|---|---|---|
| Child Physical Disabilities Respite Care | 385HR2065X | 0219037 | TN | Primary |
Addresses
Primary practice location
3129 Westchester Dr
Clarksville, TN 37043-3804
Mailing address
3129 Westchester Dr
Clarksville, TN 37043-3804
Phone (708) 359-5472
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LPN0000091074 | Other | TN | NURSING LICENSE |
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 |
|---|---|---|---|
| 0219037 | TN | MD | Child Physical Disabilities Respite Care |
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": "1871050104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3129 WESTCHESTER DR",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370433804",
"telephone_number": "708-359-5472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3129 WESTCHESTER DR",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370433804",
"telephone_number": "708-359-5472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL-BOOTH",
"first_name": "MAQUIA",
"middle_name": "MASSIRIE",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-22",
"last_updated": "2019-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "385HR2065X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Physical Disabilities, Child",
"state": "TN",
"license": "0219037",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NURSING LICENSE",
"identifier": "LPN0000091074",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
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.