Provider Demographics
NPI:1104787605
Name:KOTTER, MIKAYLA HOPE
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:HOPE
Last Name:KOTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9056 DRUMMER BAY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4677
Mailing Address - Country:US
Mailing Address - Phone:812-890-8536
Mailing Address - Fax:
Practice Address - Street 1:9056 DRUMMER BAY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4677
Practice Address - Country:US
Practice Address - Phone:812-890-8536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV891764363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily