Provider Demographics
NPI:1972318186
Name:BOTILLER, KRISTEN (FNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BOTILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W MANOR ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7044
Mailing Address - Country:US
Mailing Address - Phone:480-487-2691
Mailing Address - Fax:
Practice Address - Street 1:9305 W THOMAS RD STE 235
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3363
Practice Address - Country:US
Practice Address - Phone:623-327-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ319982207Q00000X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine