| Derek Booth, | |
|
415 N 26th St, Suite 201, Lafayette, IN 47904-2895 | |
| (765) 446-6577 | |
| Not Available |
| Full Name | Derek Booth |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner - Psychiatric/mental Health |
| Location | 415 N 26th St, Lafayette, Indiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568852986 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 71005314B (Indiana) | Primary |
| Entity Name | State of Indiana Auditor of State |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1700876224 PECOS PAC ID: 1759280118 Enrollment ID: O20040105000564 |
| Entity Name | Bloomington Meadows GP |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033298120 PECOS PAC ID: 6002707494 Enrollment ID: O20040324000255 |
| Entity Name | Valley Oaks Health Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1689629990 PECOS PAC ID: 7315927563 Enrollment ID: O20040720001286 |
| Mailing Address | Practice Location Address |
|---|---|
| Derek Booth, 415 N 26th St, Suite 201, Lafayette, IN 47904-2895 Ph: Not Available | Derek Booth, 415 N 26th St, Suite 201, Lafayette, IN 47904-2895 Ph: (765) 446-6577 |
Abigail Ann Crum, FNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 5165 Mccarty Ln, Lafayette, IN 47905 Phone: 765-448-8000 |
Kimbra Weesner, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1508 Tippecanoe St, Lafayette, IN 47904 Phone: 765-423-6400 |
Renee Nicole Siner, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1501 Hartford St Ste G525, Lafayette, IN 47904 Phone: 765-423-6224 Fax: 765-423-6910 |
Lindsay J Gebhardt, PMHNP-BC Nurse Practitioner Medicare: May Accept Medicare Assignments Practice Location: 3601 Sagamore Pkwy N Ste G, Lafayette, IN 47904 Phone: 765-739-3482 |
Mrs. Cecilia Ann Winkler, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 5500 State Road 38 E, Lafayette, IN 47905 Phone: 765-449-6790 Fax: 765-772-7113 |
Harmony Stine, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 5165 Mccarty Ln, Lafayette, IN 47905 Phone: 765-448-8000 Fax: 765-838-4758 |
Monica Michele Roadruck, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3218 Daugherty Dr Ste 140, Lafayette, IN 47909 Phone: 765-502-4190 Fax: 765-502-4191 |