Individual
STACY B BOOTH
Active
Individual
STACY B BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
PA.472
AL
363A00000X
Physician Assistant
PA.472
AL
363AS0400X
Surgical Physician Assistant
Primary
PA-472
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113209
—
AL
05
—
113211
—
AL
05
—
113213
—
AL
05
—
113243
—
AL
01
—
1821002502
TRICARE SOUTH
AL
01
—
510-49992
BCBS
AL
01
—
510-49993
BCBS
AL
01
—
510-49994
BCBS
AL
01
—
510-49995
BCBS
AL
Enumeration date
07/28/2006
Last updated
02/03/2011
Update your record
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