Nikole D Booth, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2020015335 Issued in MO

Practice address

1 Barnes Jewish Hospital PLZ
Saint Louis, MO 63110-1003

Phone

(314) 362-7509

NPI assigned

Aug 15, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1313366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1548549199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S EUCLID AVE",
            "address_2": "CAMPUS BOX 8115",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102380",
            "telephone_number": "314-362-7509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BARNES JEWISH HOSPITAL PLZ",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101003",
            "telephone_number": "314-362-7509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "NIKOLE",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-15",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA 60241973",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2020015335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rita Helen Boone, RPH
• Tracey M Boone
• Adam Lee Booth, MD
• Candice Beth Booth, MD
• Gregory Richard Booth, M.D.
• Raymond Booth, CRNA
• Therese J Booth
• Mitzi Boothe
• Rose M Boothe
• Christina E Boots, MD

• Physician Assistant in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.