Provider Demographics
NPI:1386217305
Name:BOTHWELL, TAWNYA (ARNP)
Entity Type:Individual
Prefix:
First Name:TAWNYA
Middle Name:
Last Name:BOTHWELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2862
Mailing Address - Country:US
Mailing Address - Phone:509-930-7777
Mailing Address - Fax:509-420-9843
Practice Address - Street 1:121 N 50TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2862
Practice Address - Country:US
Practice Address - Phone:509-930-7777
Practice Address - Fax:509-420-9843
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61195807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily