Provider Demographics
NPI:1588961403
Name:BOOTH, BRITTANY D (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:D
Last Name:BOOTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:B
Other - Last Name:DECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4708 CHASTANT ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2060
Mailing Address - Country:US
Mailing Address - Phone:504-813-4177
Mailing Address - Fax:
Practice Address - Street 1:100 DOLHONDE ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5801
Practice Address - Country:US
Practice Address - Phone:504-374-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200280363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02154365Medicaid
LA2315633Medicaid
MS02154365Medicaid
LA2315633Medicaid