Basic Information
| Provider Information | |||||||||
| NPI: | 1588642672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOOTH | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 CALDWELL RD | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043305739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076231322 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5 CALDWELL RD | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043305739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076231322 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 11/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | R024245 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000975 | 01 | ME | ANTHEM | OTHER | 287710099 | 05 | ME | MEDICAID | D03548 | 01 | ME | HARVARD PILGRAM | OTHER | 1041748 | 01 | ME | AETNA | OTHER | 0449265 | 01 | ME | CIGNA | OTHER |