Healthcare Provider Details

I. General information

NPI: 1972318186
Provider Name (Legal Business Name): KRISTEN BOTILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD STE 235
PHOENIX AZ
85037-3363
US

IV. Provider business mailing address

511 W MANOR ST
CHANDLER AZ
85225-7044
US

V. Phone/Fax

Practice location:
  • Phone: 623-327-4100
  • Fax:
Mailing address:
  • Phone: 480-487-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number319982
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number319982
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: