Provider Demographics
NPI:1265782593
Name:BOOTH, HILARY PARK (NP)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:PARK
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 1:1425 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4151
Mailing Address - Country:US
Mailing Address - Phone:817-926-4118
Mailing Address - Fax:817-926-4362
Practice Address - Street 1:1425 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4151
Practice Address - Country:US
Practice Address - Phone:817-926-4118
Practice Address - Fax:817-926-4362
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX827189163W00000X, 363LW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse