Tori Alyssa Kornelsen, MB BCH BAO

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1322 3Rd St SE Ste 240
Puyallup, WA 98372-3771

Phone

(235) 697-1420

NPI assigned

Jun 28, 2022

Last updated

Jun 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1023740081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1322 3RD ST SE STE 240",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 3RD ST SE STE 240",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723771",
            "telephone_number": "235-697-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORNELSEN",
        "first_name": "TORI",
        "middle_name": "ALYSSA",
        "name_prefix": "Dr.",
        "credential": "MB BCH BAO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenda M Kong III
• Jessica Nicole Kongslie, LMT
• Dinel Rose Konrad, LMP
• Gregor Konzelman, PH. D.
• Brittney Nicole Koorstad
• Korsmo & Henry DDD PS (Puyallup Family Dental)
• Korsmo & Henry DDS PS (Puyallup Family Dental)
• Kosnoski Eye Care Inc (South Hill Vision Clinic)
• Kendra Kosoff
• Danielle Helene Kostresh, BA

• Student in an Organized Health Care Education/Training Program in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Student in an Organized Health Care Education/Training Program in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.