MEDICARE: JULIE KOTELMAN DNP, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	234952	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	234952	AZ

General Provider Information

NPI Number	:	1053923912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE KOTELMAN DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-0188
Country	:	US
Telephone Number	:	520-682-4111
Fax Number	:	520-616-1442

Provider Business Practice Location Address
First Line	:	899 N WILMOT RD STE B
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1712
Country	:	US
Telephone Number	:	520-290-1100
Fax Number	:	520-290-8997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	12/08/2025

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