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General NPI Number Information
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NPI Number | 1972318186
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Entity Type | Individual
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Provider Name | KRISTEN BOTILLER FNP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 9305 W THOMAS RD STE 235
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City | PHOENIX
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State | AZ
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Zip | 85037-3363
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Country | US
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Telephone | 623-327-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 511 W MANOR ST
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City | CHANDLER
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State | AZ
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Zip | 85225-7044
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Country | US
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Telephone | 480-487-2691
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 319982
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | 319982
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License Number State | AZ
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