Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1-151734 | AL |
NPI | 1386302552 |
---|---|
Provider Name | Ashley Booth |
First Address | Mobile, AL 36604-1416 |
Second Address | Mobile, AL 36604-1416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2021 |
Last Update Date | 06/12/2021 |