Individual
MS. JESSICA SUZANNE KOHOUTEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP, RN
Contact information
Practice address
1143 47TH AVE, LONG ISLAND CITY, NY 11101-5418
(718) 551-3515
(718) 551-3580
Mailing address
205 E 73RD ST APT 12A, NEW YORK, NY 10021-3669
(212) 439-9722
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F381673
NY
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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