| Doctor Name: | MS. KATHLEEN MARIE BOOTH |
| NPI Number: | 1114057510 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RNC, NP |
| License Number: | R1226809 |
| Business Practice Address: | 2115 Summit Ave Student Health Services # 5056 St Paul, MN - 55105 |
| Business Phone Number: | 6519626750 |
| Business Fax Number: | 6519626751 |
| Mailing Address: | 7 Red Pine Rd, NORTH OAKS |
| State: | MN |
| Postal Code: | 551272030 |
| Phone Number: | 6514907863 |
| Fax Number: | 6514907863 |
| NPI Enumeration Date: | 03/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R1226809 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |