Healthcare Provider Details

I. General information

NPI: 1518581792
Provider Name (Legal Business Name): VETRICE KOTEK PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VETRICE TURNER APRN

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902 PEARL RD STE 502
PARMA OH
44130-3621
US

IV. Provider business mailing address

14864 RAPIDS RD
BURTON OH
44021-9414
US

V. Phone/Fax

Practice location:
  • Phone: 440-842-6867
  • Fax:
Mailing address:
  • Phone: 440-708-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0027357
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: