KELLEY C BOOTH (NPI# 1053830851) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053830851 |
| Entity Type | Individual |
| Full Name | KELLEY C BOOTH |
| Credential | NP |
| Practice Address |
2850 Telegraph Ave Ste 120 Berkeley CA 94705-1159 |
| Mailing Address |
325 Distel Cir Los Altos CA 94022-1408 |
| Practice Telephone | (510) 204-8140 |
| Mailing Telephone | 5102048290 |
| Mailing Fax Number | 5105067725 |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2019-08-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
95007295 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | FEDERAL DEA LICENSE | MB4499148 | 01 |
| CA | STATE MEDICAL LICENSE | NP95007295 | 01 |
| Street Address |
2850 TELEGRAPH AVE STE 120 |
| City | BERKELEY |
| State | CA |
| Zip Code | 94705-1159 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205953247 | Jennifer Ault | Psychiatry & Neurology | 2850 Telegraph Ave Ste 120, Berkeley, CA 94705-1159 | 2007-03-23 |
| 1912561689 | Juliana Rachel Fritz | Physician Assistant | 2850 Telegraph Ave Ste 120, Berkeley, CA 94705-1159 | 2019-04-27 |
| 1699193888 | Christina Kwan | Internal Medicine | 2850 Telegraph Ave Ste 120, Berkeley, CA 94705-1159 | 2014-04-03 |
| 1760825806 | Sepehr Rejai | Pain Medicine | 2850 Telegraph Ave Ste 120, Berkeley, CA 94705 | 2013-04-08 |
| 1902149263 | Joshua John Samuel | Internal Medicine | 2850 Telegraph Ave Ste 120, Berkeley, CA 94705 | 2013-04-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447882956 | Diane Lomas Wyatt | Marriage & Family Therapist | 2340 Ward St. Ste 104, Berkeley, CA 94705 | 2020-02-12 |
| 1700371275 | Icecreamwala Dermatology Inc | Dermatology | 2435 Webster St Ste 101, Berkeley, CA 94705 | 2018-06-27 |
| 1396253803 | David R Shaddock | Marriage & Family Therapist | 3030 Ashby Avenue, # 105, Berkeley, CA 94705 | 2018-01-18 |
| 1821504432 | Allegra Tringali | Physical Therapist | 2450 Ashby Ave Fl 6, Berkeley, CA 94705 | 2017-12-19 |
| 1659898740 | Hunter Brown | Student in an Organized Health Care Education/Training Program | Wright Institute Clinical Services 1918 University Ave, Suite 2b, Berkeley, CA 94705 | 2017-08-29 |
| 1588014534 | Heather Valdez | Social Worker | 2185 Ashby Ave, Berkeley, CA 94705 | 2016-06-20 |
| 1215350145 | S.e.e.d.s. (social and Emotional Education Development and Support) | Community/Behavioral Health | 3120 Telegraph Avenue Ste 9, Berkeley, CA 94705 | 2014-01-29 |
| 1144580960 | Benjamin Tucker | Counselor | 2625 Alcatraz Ave Ste 609, Berkeley, CA 94705 | 2012-05-26 |
| 1881966141 | Jennifer Cowherd | Behavioral Analyst | 2201 Woolsey St, Berkeley, CA 94705 | 2012-02-02 |
| 1518255892 | Erika D Huguenard | Counselor | 2811a College Avenue, Berkeley, CA 94705 | 2011-07-20 |
| Find all providers in zip 94705 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861967622 | Liliana Teves Sierra | Nurse Practitioner | 837 Addison St, Berkeley, CA 94710 | 2018-10-09 |
| 1295210995 | Brian Christopher Vassalo | Nurse Practitioner | 1528 Woolsey St Apt D, Berkeley, CA 94703-2353 | 2018-09-27 |
| 1942710140 | Laila Rania Tannura | Nurse Practitioner | 837 Addison St., Berkeley, CA 94710 | 2017-10-03 |
| 1275063323 | Alice Mak | Nurse Practitioner | 3154 College Ave Apt 2, Berkeley, CA 94705-2747 | 2017-06-12 |
| 1174996839 | Niccole Blanchet | Nurse Practitioner | 3095 Telegraph Ave, Berkeley, CA 94705-2035 | 2015-11-03 |
| 1497996953 | Tamra Leigh Groode | Nurse Practitioner | 2701 Martin Luther King Jr Way, Berkeley, CA 94703-2165 | 2009-03-13 |
| 1306066576 | Gretchen Leslie Meyer | Nurse Practitioner | 2016 Delaware St # A, Berkeley, CA 94709-2122 | 2007-04-27 |
| 1285765313 | Mythilla Karunaratne | Nurse Practitioner | 2999 Regent St Ste 425, Berkeley, CA 94705-2119 | 2007-03-08 |
| 1144358532 | Pam Elizabeth Cameron | Nurse Practitioner | University Health Servcices 2222 Bancroft Way, Berkeley, CA 94720-4300 | 2007-02-28 |
| 1497851653 | Maile Concolino Matier | Nurse Practitioner | 2222 Bancroft Ext # 4300, Berkeley, CA 94720-4300 | 2006-09-15 |
| Find all providers in BERKELEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.