| Doctor Name: | CARRIE JEAN BOOTS |
| NPI Number: | 1003012352 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 71002416A |
| Business Practice Address: | 7910 W Jefferson Blvd Suite 108 Fort Wayne, IN - 468044159 |
| Business Phone Number: | 2604848830 |
| Business Fax Number: | 2604831911 |
| Mailing Address: | Po Box 15099, FORT WAYNE |
| State: | IN |
| Postal Code: | 468855099 |
| Phone Number: | 2604848830 |
| Fax Number: | 2604831911 |
| NPI Enumeration Date: | 06/25/2007 |
| NPI Last Update Date: | 10/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 71002416A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |