Healthcare Provider Details

I. General information

NPI: 1679530166
Provider Name (Legal Business Name): J LATAYNE ROTHMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 W AMARILLO BLVD
AMARILLO TX
79106-1990
US

IV. Provider business mailing address

5116 HARVARD ST
AMARILLO TX
79109-5806
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-9702
  • Fax: 806-468-1807
Mailing address:
  • Phone: 806-355-9702
  • Fax: 806-468-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number438983
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: