Provider Demographics
NPI:1477799922
Name:BOTKIN, REBECCA LYNNE (APN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:BOTKIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNNE
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P O BOX 811
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0811
Mailing Address - Country:US
Mailing Address - Phone:903-614-5355
Mailing Address - Fax:903-735-5399
Practice Address - Street 1:610 N LOOP 336 E
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1437
Practice Address - Country:US
Practice Address - Phone:281-816-7333
Practice Address - Fax:346-998-1442
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V103Medicare PIN