Provider Demographics
NPI:1285697631
Name:BOOTH, BARBARA BEBE (MS,RN,CNS)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:BEBE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MS,RN,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 17TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3703
Mailing Address - Country:US
Mailing Address - Phone:320-762-1511
Mailing Address - Fax:
Practice Address - Street 1:700 CEDAR ST
Practice Address - Street 2:STE 154
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1769
Practice Address - Country:US
Practice Address - Phone:320-762-2400
Practice Address - Fax:320-762-8047
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0677530364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN928011040901OtherPREFERREDONE
MNHP51546OtherHEALTHPARTNERS
MNP00430374OtherRAILROAD MEDICARE
MN089257200Medicaid
MN890000268Medicare ID - Type Unspecified
MNHP51546OtherHEALTHPARTNERS