Provider Demographics
NPI:1447550710
Name:MOTYCKA, JENNA MICHELE (APRN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MICHELE
Last Name:MOTYCKA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MICHELE
Other - Last Name:BRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-6815
Mailing Address - Fax:812-450-6822
Practice Address - Street 1:600 MARY STREET
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47747-2306
Practice Address - Country:US
Practice Address - Phone:812-450-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003453A363L00000X, 363LF0000X
IN28164496A363LF0000X
KY3007267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201014300Medicaid
KY7100188900Medicaid
IN201014300Medicaid
IN249390005Medicare PIN