Healthcare Provider Details

I. General information

NPI: 1699606483
Provider Name (Legal Business Name): JOSHUA E BOTCHWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 BRYANT MEADOWS DR
SPRING TX
77386-1060
US

IV. Provider business mailing address

4815 BRYANT MEADOWS DR
SPRING TX
77386-1060
US

V. Phone/Fax

Practice location:
  • Phone: 518-961-3899
  • Fax:
Mailing address:
  • Phone: 518-961-3899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA BOTCHWAY
Title or Position: OWNER
Credential: MSN
Phone: 518-961-3899