Booty, Jeremy

Booty, Jeremy is an individual health care provider with primary practice located at 47 Town St , Norwich CT 06360-2323. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as his primary health care specialty. Booty, Jeremy can be contacted via phone (860) 892-7042.

Contact Information

Primary practice address
47 Town St Norwich CT 06360-2323
Phone: (860) 892-7042
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 5947 Connecticut

Profile Details

NPI number 1669877189
LBN Legal business name Booty, Jeremy
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 27th, 2014
Last updated Jan 20th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669877189 NPPES
Connecticut MEDICAID 008056298

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