MEDICARE: MS. SARAH LOUISE BOOTH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	425838	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689676090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH LOUISE BOOTH NP

Provider Business Mailing Address
First Line	:	PO BOX 90345
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-9083
Country	:	US
Telephone Number	:	210-392-0018
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 LEXINGTON AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1930
Country	:	US
Telephone Number	:	210-392-0018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	12/05/2013

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