Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | APN6911 | TN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 6911 | TN |
NPI | 1114014214 |
---|---|
Provider Name | Rebecca Botts |
First Address | Jackson, TN 38305-5514 |
Second Address | Springfield, TN 37172-4510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01756 | (02) |