Provider Demographics
NPI:1902326598
Name:BOTANNY, BYLLY JEANN (DNP, AGPCNP-C,RN)
Entity type:Individual
Prefix:MS
First Name:BYLLY
Middle Name:JEANN
Last Name:BOTANNY
Suffix:
Gender:F
Credentials:DNP, AGPCNP-C,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # MCM-14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-8871
Practice Address - Street 1:480 GALLETTI WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5544
Practice Address - Country:US
Practice Address - Phone:775-982-8870
Practice Address - Fax:775-982-8871
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV855888163WX0106X, 363LG0600X, 363LP2300X, 363LX0106X, 363LA2200X
NV246RP1900X
TXAP133859363LA2200X, 363LG0600X, 363LP2300X
TXAP133895363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health