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General NPI Number Information
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NPI Number | 1184191868
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Entity Type | Individual
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Provider Name | JESSICA BOTTS PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 755 S PERRY ST STE 100
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City | CASTLE ROCK
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State | CO
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Zip | 80104-1923
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Country | US
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Telephone | 303-688-8989
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Fax |
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Provider Business Mailing Address
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Address Line | 600 W COUNTY LINE RD APT 27-103
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-6534
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Country | US
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Telephone | 661-623-6594
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0005613
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License Number State | CO
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