Provider Demographics
NPI:1992572556
Name:BOOHER, MISTI DAWN (PA)
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:DAWN
Last Name:BOOHER
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1315
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-1315
Mailing Address - Country:US
Mailing Address - Phone:864-635-0376
Mailing Address - Fax:864-442-6848
Practice Address - Street 1:321 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3447
Practice Address - Country:US
Practice Address - Phone:646-350-3768
Practice Address - Fax:864-442-6848
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC5167363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant