MEDICARE: JENNIFER LYNN KOTSANIS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	83060	WV
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.14147	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427495639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN KOTSANIS NP

Provider Business Mailing Address
First Line	:	302 W MAIN ST
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-8801
Country	:	US
Telephone Number	:	740-968-7006
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 W MAIN ST
Second Line	:
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-8801
Country	:	US
Telephone Number	:	740-968-7256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	11/03/2017

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