Provider Demographics
NPI:1215321484
Name:BOOHER, JESSICA TERESA (RN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:TERESA
Last Name:BOOHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:TERESA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1429
Mailing Address - Country:US
Mailing Address - Phone:813-784-5670
Mailing Address - Fax:
Practice Address - Street 1:11 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1429
Practice Address - Country:US
Practice Address - Phone:813-784-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC221291163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse