Provider Demographics
NPI:1689676090
Name:BOOTH, SARAH LOUISE (NP)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:LOUISE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90345
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-9083
Mailing Address - Country:US
Mailing Address - Phone:210-392-0018
Mailing Address - Fax:
Practice Address - Street 1:516 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1930
Practice Address - Country:US
Practice Address - Phone:210-392-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX425838363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023940901Medicaid
TX042549802Medicaid
TX042549802Medicaid
TX023940901Medicaid