Provider Demographics
NPI:1518581792
Name:KOTEK, VETRICE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:VETRICE
Middle Name:
Last Name:KOTEK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MISS
Other - First Name:VETRICE
Other - Middle Name:
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:14864 RAPIDS RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021-9414
Mailing Address - Country:US
Mailing Address - Phone:440-708-3631
Mailing Address - Fax:
Practice Address - Street 1:6902 PEARL RD STE 502
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-3621
Practice Address - Country:US
Practice Address - Phone:440-842-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH0027357363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty