=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144026907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DASHARA P BOOTH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2025
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 HIGHWAY 84 W
-----------------------------------------------------
City | COLLINS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39428-4929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-223-2803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6116 N WILLIAMSBURG RD
-----------------------------------------------------
City | BASSFIELD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39421-4111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-223-2803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------