Provider Demographics
NPI:1881774883
Name:BOOTH, KAREN MEISENBACH (PAC)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MEISENBACH
Last Name:BOOTH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:RENEE
Other - Last Name:MEISENBACCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:984-215-4110
Mailing Address - Fax:
Practice Address - Street 1:2605 BLUE RIDGE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-787-3448
Practice Address - Fax:919-232-0006
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000196363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013NAMedicaid
NC89013NAMedicaid