Basic Information
| Provider Information | |||||||||
| NPI: | 1912589177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOOTHE | ||||||||
| FirstName: | KANDIS | ||||||||
| MiddleName: | WRIGHT | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD, PHD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WRIGHT | ||||||||
| OtherFirstName: | KANDIS | ||||||||
| OtherMiddleName: | LAYNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1501 N. CAMPBELL AVE. PO BOX 245040 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857245035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206266349 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1625 N CAMPBELL AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857194330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206948888 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2021 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R78560 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.