Provider Demographics
NPI:1801548433
Name:KOTOPKA, JESSICA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:KOTOPKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2091 BOX BUTTE AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301
Mailing Address - Country:US
Mailing Address - Phone:308-762-7244
Mailing Address - Fax:308-762-6657
Practice Address - Street 1:2091 BOX BUTTE AVE STE 700
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301
Practice Address - Country:US
Practice Address - Phone:308-762-7244
Practice Address - Fax:308-762-6657
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2704363A00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant