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General NPI Number Information
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NPI Number | 1407087034
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Entity Type | Individual
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Provider Name | SHANI GORIO BOOTH ANP, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 42334 DELUXE PLZ STE 2
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City | HAMMOND
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State | LA
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Zip | 70403-1237
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Country | US
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Telephone | 985-662-5520
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Fax |
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Provider Business Mailing Address
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Address Line | 1752 OX BOW LN
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City | COVINGTON
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State | LA
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Zip | 70433-7273
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Country | US
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Telephone | 985-507-8436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP05920
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP05920
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License Number State | LA
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