Individual
ANGELA LYNN BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
615 SHIPYARD BLVD, WILMINGTON, NC 28412-6431
(910) 343-0145
(910) 202-9966
Mailing address
615 SHIPYARD BLVD, WILMINGTON, NC 28412-6431
(910) 343-0145
(910) 202-9966
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001007254
NC
363AM0700X
Medical Physician Assistant
001007254
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174971600
—
NC
05
—
3542PA
—
SC
Enumeration date
05/25/2016
Last updated
05/04/2022
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