Provider Demographics
NPI:1003299272
Name:COTTON, JESSICA L (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:COTTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:5161 B DR S
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9345
Mailing Address - Country:US
Mailing Address - Phone:269-969-6099
Mailing Address - Fax:269-969-6089
Practice Address - Street 1:5161 B DR S
Practice Address - Street 2:SUITE A
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9345
Practice Address - Country:US
Practice Address - Phone:269-969-6099
Practice Address - Fax:269-969-6089
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244423363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA36077017Medicare PIN