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General NPI Number Information
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NPI Number | 1699655522
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Entity Type | Individual
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Provider Name | DEZMON BOTT
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Gender | Male
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 460 SPRING ST
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3452
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Country | US
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Telephone | 502-919-5392
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Fax |
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Provider Business Mailing Address
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Address Line | 102 SOUTHVIEW TER
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City | LOUISVILLE
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State | KY
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Zip | 40214-4220
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Country | US
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Telephone |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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