Healthcare Provider Details

I. General information

NPI: 1801548433
Provider Name (Legal Business Name): JESSICA ANNE KOTOPKA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA ANNE HARTMAN PA-C

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 07/12/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 BOX BUTTE AVE STE 700
ALLIANCE NE
69301
US

IV. Provider business mailing address

2091 BOX BUTTE AVE STE 700
ALLIANCE NE
69301
US

V. Phone/Fax

Practice location:
  • Phone: 308-762-7244
  • Fax: 308-762-6657
Mailing address:
  • Phone: 308-762-7244
  • Fax: 308-762-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2704
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2704
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: