Provider Demographics
NPI:1982930731
Name:COTTENOIR, KEZIA E (APNP)
Entity Type:Individual
Prefix:
First Name:KEZIA
Middle Name:E
Last Name:COTTENOIR
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E. COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911
Mailing Address - Country:US
Mailing Address - Phone:806-765-2600
Mailing Address - Fax:806-765-2604
Practice Address - Street 1:3301 CLOVIS ROAD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415
Practice Address - Country:US
Practice Address - Phone:806-765-2611
Practice Address - Fax:806-765-2604
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX569257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily