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General NPI Number Information
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NPI Number | 1700119047
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Entity Type | Individual
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Provider Name | JESSICA A KOURY AA
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Gender | Female
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 36000 EUCLID AVE
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4625
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Country | US
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Telephone | 440-350-0832
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Fax | 440-579-0191
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Provider Business Mailing Address
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Address Line | 7757 AUBURN RD UNIT 15
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City | PAINESVILLE
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State | OH
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Zip | 44077-9609
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Country | US
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Telephone | 440-350-0823
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Fax | 440-354-7420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 67.000157
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License Number State | OH
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