Provider Demographics
NPI:1821071515
Name:BOOTH, BRANDI L (ARNP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:L
Last Name:BOOTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-3121
Mailing Address - Country:US
Mailing Address - Phone:641-842-2151
Mailing Address - Fax:
Practice Address - Street 1:104 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:IA
Practice Address - Zip Code:50225-9312
Practice Address - Country:US
Practice Address - Phone:515-848-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA091098363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0463463Medicaid
IAQ43395Medicare UPIN
IAI15166Medicare ID - Type Unspecified