Active NPI
Jil Diane Bottrell, PH.D.
- Cognitive & Behavioral Psychologist
- Fairbanks, AK
National Provider Identifier
1770702524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- 176
- Practice address
- 600 University Ave
Fairbanks, AK 99709-3643 - Phone
- (907) 457-4177
- NPI assigned
- Apr 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 176 | AK | Primary |
Addresses
Primary practice location
600 University Ave
Fairbanks, AK 99709-3643
Mailing address
4054 Teal Ave
Fairbanks, AK 99709-3520
Phone (907) 479-4177
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 176 | AK | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770702524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4054 TEAL AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997093520",
"telephone_number": "907-479-4177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 UNIVERSITY AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997093643",
"telephone_number": "907-457-4177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOTTRELL",
"first_name": "JIL",
"middle_name": "DIANE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "AK",
"license": "176",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.