Healthcare Provider Details

I. General information

NPI: 1568973956
Provider Name (Legal Business Name): JESSICA SUE KOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA HULET

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 W 22ND ST
OAK BROOK IL
60523-1225
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 630-572-1232
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number209016837
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number277-003059
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016837
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16335
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277-003059
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: