STACY B BOOTH PA-C NPI 1821002502

NPI Information

NPI: 1821002502
Provider Name: STACY B BOOTH, PA-C
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

Organization: KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

PECOS Registration: Yes

Address:
5 MOBILE INFIRMARY CIR
MOBILE, AL
ZIP 36607
Phone: (251) 435-2646
Get Directions

Stacy B Booth, PA-C is a surgical physician assistant in Mobile, AL with 26 years of experience. Stacy B Booth, PA-C NPI is 1821002502. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE
Graduation Year:1998

The provider's business location address is:

5 MOBILE INFIRMARY CIR
MOBILE, AL
ZIP 36607-513
Phone: (251) 435-2646
Fax: (251) 435-6478

The NPI 1821002502 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/28/2006 and was last updated on 2/3/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363A00000X	Physician Assistant		PA.472	ALABAMA	No
2	207P00000X	Emergency Medicine		PA.472	ALABAMA	No
3	363AS0400X	Physician Assistant	Surgical	PA-472	ALABAMA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1821002502	OTHER	ALABAMA	TRICARE SOUTH
2	510-49994	OTHER	ALABAMA	BCBS
3	510-49992	OTHER	ALABAMA	BCBS
4	102I970025	MEDICARE PIN	ALABAMA
5	113243	MEDICAID	ALABAMA
6	113209	MEDICAID	ALABAMA
7	510-49995	OTHER	ALABAMA	BCBS
8	510-49993	OTHER	ALABAMA	BCBS
9	S64752	MEDICARE UPIN
10	113211	MEDICAID	ALABAMA
11	113213	MEDICAID	ALABAMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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