Individual
JOHNA MARIE BOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2125 STATE ST STE 5, NEW ALBANY, IN 47150-4901
(502) 222-0028
(502) 222-0029
Mailing address
1006 NEW MOODY LN, LA GRANGE, KY 40031-9122
(502) 222-0028
(502) 222-0029
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1562
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100130280
—
KY
Enumeration date
07/09/2010
Last updated
12/08/2020
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