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General NPI Number Information
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NPI Number | 1376338319
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Entity Type | Individual
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Provider Name | KIMBERLY M BOTT CNP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 2150 W CENTRAL AVE
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City | TOLEDO
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State | OH
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Zip | 43606-3834
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Country | US
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Telephone | 419-291-2192
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Fax |
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Provider Business Mailing Address
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Address Line | 8400 WHITEFORD CENTER RD
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City | OTTAWA LAKE
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State | MI
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Zip | 49267-9541
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Country | US
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Telephone | 248-935-2975
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 370835
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.0032291
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License Number State | OH
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