| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ROGER MARK BOOTH | 1275150047 | 2020-06-28 |
Roger Mark Booth is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1275150047. Registration indicates Roger Mark Booth is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Gerontology, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Gerontology, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| Entity Type | Individual |
| Provider Name | Mr. Roger Mark Booth Jr. NP-C |
| Practice Office Address | 1540 SPRING VALLEY DR HUNTINGTON, WV US |
| Practice Office Telephone | 3046544035 |
| Mailing Address | 1540 SPRING VALLEY DR HUNTINGTON, WV 257049501 US |
| Business Telephone | 3046544035 |
| CONNECT URL [] | Huntington |
| Code | Practice | License No State |
|---|---|---|
| 363LG0600X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Gerontology All Other Specialties & Provider Types Nurse Practitioner Gerontology Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 105246
WV |