Provider Demographics
NPI:1124037429
Name:KOTT, KATHRYN B (APRN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:B
Last Name:KOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MARGARET
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5491 DOLPHIN POINT BLVD.
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211
Mailing Address - Country:US
Mailing Address - Phone:904-256-8082
Mailing Address - Fax:904-256-8081
Practice Address - Street 1:5491 DOLPHIN POINT BLVD.
Practice Address - Street 2:SUITE 1300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211
Practice Address - Country:US
Practice Address - Phone:904-256-8082
Practice Address - Fax:904-256-8081
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006919363LF0000X
WI530363LF0000X
FLAPRN9496831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1124037429Medicaid
WI1124037429Medicaid
004580035Medicare ID - Type Unspecified