Healthcare Provider Details

I. General information

NPI: 1952282139
Provider Name (Legal Business Name): JERICHO KEEPER KOCOT FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 LAPEER AVE
SAGINAW MI
48607-1203
US

IV. Provider business mailing address

2578 E PINCONNING RD
PINCONNING MI
48650-9339
US

V. Phone/Fax

Practice location:
  • Phone: 989-753-6000
  • Fax:
Mailing address:
  • Phone: 989-233-9262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025244994
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: