Healthcare Provider Details

I. General information

NPI: 1477923316
Provider Name (Legal Business Name): LINDA KATHRYN BOTTS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 RANDOLPH ST
THOMASVILLE NC
27360-5785
US

IV. Provider business mailing address

1616 E MILLBROOK RD STE 110
RALEIGH NC
27609-4971
US

V. Phone/Fax

Practice location:
  • Phone: 336-860-0843
  • Fax: 336-313-5944
Mailing address:
  • Phone: 919-341-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0815035
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5008079
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: