Individual provider · NPI-1

Marissa B Bothun, P.A.-C.

Physician Assistant · Rockwall, TX

NPI number1942507207
StatusActive
Last updated in NPPESDec 8, 2025

Details

NPI
1942507207
Entity type
Individual (NPI-1)
Name
Marissa B Bothun
Credential
P.A.-C.
Sex
Female
Sole proprietor
No
Enumeration date
Feb 23, 2011
Certification date
Dec 8, 2025
Last updated
Dec 8, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician AssistantPA07230TXYes

Other names

  • Marissa B Bothun (Other Name)

Practice location

1020 W Ralph Hall Pkwy Ste 102
Rockwall, TX 75032-8711

Phone 972-390-9002 · Fax 972-722-3553

Mailing address

1790 N Stonebridge Dr
Mckinney, TX 75071-7437

Phone 972-390-9002 · Fax 214-491-3777

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