Provider Demographics
NPI:1043917297
Name:BOTTERBUSH, JACLYN NICOLE (APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:NICOLE
Last Name:BOTTERBUSH
Suffix:
Gender:
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:NICOLE
Other - Last Name:HELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 DUNHILL PL NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 DUNHILL PL NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3866
Practice Address - Country:US
Practice Address - Phone:423-476-2212
Practice Address - Fax:423-476-7022
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33639363LF0000X
TN199030163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult