Shannon Dee Booth, MSN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

182979 Issued in AK

Practice address

1363 W Spruce Ave
Wasilla, AK 99654-5327

Phone

(907) 376-2411

NPI assigned

Nov 3, 2021

Last updated

Mar 19, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AK, HI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kau HospitalGroup PAC ID 7416945548, 138 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kau Hospital Hospital, Pahala, HI, CCN 121301

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• HI PPO

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: shannon.booth.p1@direct.mshs.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kau Hospital

  • Rural Health Clinic/Center
  • Pahala, HI
  • NPI 1144304338
  Medicare reassignment Care Compare group NPD
• Mat - Su Health Services Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wasilla, AK
  • NPI 1184725210
  Medicare reassignment NPD
• Kau Hospital

  dba East Hawaii Health Clinic at Puna Kai

  • Rural Health Clinic/Center
  • Pahoa, HI
  • NPI 1285450163
  NPD
• Kau Hospital

  • Critical Access Hospital
  • Pahala, HI
  • NPI 1982276127
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Kau Hospital

  • Critical Access Hospital
  • Pahala, HI
  • NPI 1558441311
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1083379184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1363 W SPRUCE AVE",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996545327",
            "telephone_number": "907-376-2411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1363 W SPRUCE AVE",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996545327",
            "telephone_number": "907-376-2411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3261 S Big Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Big Lake",
            "state": "AK",
            "postal_code": "996239663",
            "country_code": "US",
            "telephone_number": "907-376-2411",
            "fax_number": "907-352-3663",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "425 E Dahlia Ave Ste M",
            "address_purpose": "LOCATION",
            "city": "Palmer",
            "state": "AK",
            "postal_code": "996456463",
            "country_code": "US",
            "telephone_number": "907-376-2411",
            "fax_number": "907-352-3363",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "SHANNON",
        "middle_name": "DEE",
        "credential": "MSN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-03",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AK",
            "license": "182979",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "HI",
            "license": "APRN-4445",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AK",
            "license": "174083",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leonard Bolog, R.PH.
• Ashley Bolte, PSYD
• Sarah Bond
• Winona Lynnette Bone
• Jayme Bonty
• Kara Lynn Boothby, PA-C
• Matthew Gregory Boothe, DDS
• Denali Michelle Borchardt
• Donna Borchardt
• Emily Bordelon

• Psychiatric/Mental Health Nurse Practitioner in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Psychiatric/Mental Health Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.