Provider Demographics
NPI:1750693958
Name:BOOTH, ACALYNN MARCUM (RN)
Entity type:Individual
Prefix:MRS
First Name:ACALYNN
Middle Name:MARCUM
Last Name:BOOTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 2066
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570-9637
Mailing Address - Country:US
Mailing Address - Phone:304-272-3896
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 2066
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570-9637
Practice Address - Country:US
Practice Address - Phone:304-272-3896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH367135163W00000X
KY50483163W00000X
WV80236163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse