Provider Demographics
NPI:1144026907
Name:BOOTH, DASHARA P
Entity type:Individual
Prefix:
First Name:DASHARA
Middle Name:P
Last Name:BOOTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 N WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BASSFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39421-4111
Mailing Address - Country:US
Mailing Address - Phone:769-223-2803
Mailing Address - Fax:
Practice Address - Street 1:51 HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-4929
Practice Address - Country:US
Practice Address - Phone:769-223-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health