| NPI | 1194206128 |
|---|---|
| Former Name | HEATHER LYNN BOOTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2203) |
| 363AM0700X Physician Assistant Medical (Licence: OH 50.005786RX) | |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2023-12-26 |