Healthcare Provider Details
I. General information
NPI: 1992323059
Provider Name (Legal Business Name): AVERI BROOKELYN SMITH BOTTS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/06/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
232 MARKET ST
FLOWOOD MS
39232-3339
US
IV. Provider business mailing address
1105 OAK ST
OCEAN SPRINGS MS
39564-8921
US
V. Phone/Fax
- Phone: 866-849-0692
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 35813 |
| License Number State | TN |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 89068 |
| License Number State | NM |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | ARNP.AP.70119731-NP |
| License Number State | WA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 0024197212 |
| License Number State | VA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | A190777 |
| License Number State | IA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | C-APN.0106500-C-NP |
| License Number State | CO |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | LG-0013906 |
| License Number State | DE |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 0041958 |
| License Number State | OH |
| # 9 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 3-000030 |
| License Number State | AL |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 116847 |
| License Number State | NE |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 227891 |
| License Number State | AR |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 903103 |
| License Number State | MS |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
