Healthcare Provider Details

I. General information

NPI: 1669388823
Provider Name (Legal Business Name): KOJO OTCHERE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W CENTER ST
MARION OH
43302-3704
US

IV. Provider business mailing address

831 EPIC DR
LEWIS CENTER OH
43035-7866
US

V. Phone/Fax

Practice location:
  • Phone: 740-751-6380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0043145
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: