Provider Demographics
NPI:1912589177
Name:BOOTHE, KANDIS WRIGHT (MD, PHD)
Entity type:Individual
Prefix:
First Name:KANDIS
Middle Name:WRIGHT
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:KANDIS
Other - Middle Name:LAYNE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3506 21ST ST BLDG 14
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1212
Mailing Address - Country:US
Mailing Address - Phone:806-725-4130
Mailing Address - Fax:253-682-1714
Practice Address - Street 1:3615 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1203
Practice Address - Country:US
Practice Address - Phone:806-725-4130
Practice Address - Fax:253-682-1714
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2025-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72561207R00000X
TXV3250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine