Provider Demographics
NPI:1740910413
Name:KOTNER, JOSHUA (MS)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:KOTNER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 WALLEN RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-8458
Mailing Address - Country:US
Mailing Address - Phone:619-947-0228
Mailing Address - Fax:
Practice Address - Street 1:2199 N MERRIT CRK LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4949
Practice Address - Country:US
Practice Address - Phone:619-947-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant