Provider Demographics
NPI:1114603867
Name:BOTKIN, KATHRYN GENEVIEVE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GENEVIEVE
Last Name:BOTKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 S 158TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2329
Mailing Address - Country:US
Mailing Address - Phone:402-718-6829
Mailing Address - Fax:
Practice Address - Street 1:6003 S 158TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-2329
Practice Address - Country:US
Practice Address - Phone:402-718-6829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program