Provider Demographics
NPI:1891680013
Name:BOOTHE, JARED
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:BOOTHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 INGALLS ST APT 101
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214-8308
Mailing Address - Country:US
Mailing Address - Phone:520-475-7720
Mailing Address - Fax:
Practice Address - Street 1:2615 INGALLS ST APT 101
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:CO
Practice Address - Zip Code:80214-8308
Practice Address - Country:US
Practice Address - Phone:520-475-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program