Jillian Rae Koterba, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704279051 Issued in MI

Practice address

713 Hollywood Dr
Owosso, MI 48867-1109

Phone

(989) 205-7086

NPI assigned

Jan 19, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

Interoperability endpoints

• Direct secure messaging: jkoterba1015759@direct.hfhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Genesee Office of Controller

  • Public Health or Welfare Agency
  • Flint, MI
  • NPI 1154370344
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1497407688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 HOLLYWOOD DR",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "488671109",
            "telephone_number": "989-205-7086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 HOLLYWOOD DR",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "488671109",
            "telephone_number": "989-205-7086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTERBA",
        "first_name": "JILLIAN",
        "middle_name": "RAE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-19",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704279051",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704279051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Knight Drugs Owosso, Inc.
• Sanaa Knox, LLMSW
• Rebecca Kocan
• Amanda Koch
• Dana Lyle Kong, DDS
• Michael Bryan Kramer, DO
• Andrea Krane
• Maddison Marie Krauss
• Addison Mae Kregger
• Mallory Madeline Kritzer, PA-C

• Family Nurse Practitioner in Owosso, MI
• Providers in Owosso, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.