Individual
JILL COTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2115 S FREMONT AVE, STE 3300, SPRINGFIELD, MO 65804-2239
(417) 820-5200
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(855) 420-7900
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2000151477
MO
363LG0600X
Gerontology Nurse Practitioner
Primary
2016036907
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AR
05
—
PENDING
—
MO
Enumeration date
09/01/2016
Last updated
10/18/2016
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