Provider Demographics
NPI:1144558412
Name:SMITH, JULIE BOOHER (FNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:BOOHER
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:BROOKE
Other - Last Name:BOOHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:317 N HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2428
Mailing Address - Country:US
Mailing Address - Phone:931-528-7527
Mailing Address - Fax:
Practice Address - Street 1:317 N HICKORY AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2428
Practice Address - Country:US
Practice Address - Phone:931-528-7527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14372363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily