Provider Demographics
NPI:1124763636
Name:KOHTZ, JORDYN LYNN
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:LYNN
Last Name:KOHTZ
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 1:1400 R ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68588-0007
Mailing Address - Country:US
Mailing Address - Phone:402-472-7211
Mailing Address - Fax:
Practice Address - Street 1:841 N 14TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68588-1282
Practice Address - Country:US
Practice Address - Phone:402-472-3467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program