Judith Alison Boomer, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA03356 Issued in TX

Practice address

4515 Marsha Sharp Fwy
Lubbock, TX 79407-2520

Phone

(806) 744-7223

Fax

(806) 740-3325

NPI assigned

Apr 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Judith Alison Clarke Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Covenant Medical Group

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1376598904
  NPD (past)

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462838400000",
    "number": "1912960733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2804 N LOOP 289",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794151410",
            "telephone_number": "806-744-7223",
            "fax_number": "806-740-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 MARSHA SHARP FWY",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794072520",
            "telephone_number": "806-744-7223",
            "fax_number": "806-740-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOMER",
        "first_name": "JUDITH",
        "middle_name": "ALISON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2016-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUDITH",
            "last_name": "CLARKE",
            "middle_name": "ALISON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Allison Bonner
• Justin Drew Bonner, D.D.S.
• Holli Booe
• Booker Hospital District
• Kendra Franklin Bookout, M.D.
• Matthew Lewis Boomer
• Timothy Lewis Boomer, PA-C
• Amy M Boone, SLP-ASSISTANT
• Stacy Boone, P.A.
• Boonipat Craniofacial and Facial Plastic Surgery

• Physician Assistant in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.