Provider Demographics
NPI:1841332012
Name:BOOKER, VARANISE COLBERT (M,D)
Entity type:Individual
Prefix:DR
First Name:VARANISE
Middle Name:COLBERT
Last Name:BOOKER
Suffix:
Gender:F
Credentials:M,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E BRECKINRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2328
Mailing Address - Country:US
Mailing Address - Phone:502-777-7708
Mailing Address - Fax:502-561-1113
Practice Address - Street 1:302 E BRECKINRIDGE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2328
Practice Address - Country:US
Practice Address - Phone:502-777-7708
Practice Address - Fax:502-561-1113
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY339232084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64053523Medicaid
KY1915501Medicare ID - Type Unspecified
KY64053523Medicaid