Katherine Phouthavong, N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

341143 Issued in NY

Practice address

601 Elwood Ave
Box Surg/TXP
Rochester, NY 14642-0001

Phone

(585) 275-5875

NPI assigned

Oct 6, 2016

Last updated

Oct 6, 2016By 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 NY

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

State licenses

Interoperability endpoints

• Direct secure messaging: ms_kphoutha@landmarkhealth-direct.org

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

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475712000000",
    "number": "1033669726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 DERRICK DR",
            "city": "WEST HENRIETTA",
            "state": "NY",
            "postal_code": "145868915",
            "telephone_number": "585-576-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 ELWOOD AVE",
            "address_2": "BOX SURG/TXP",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001",
            "telephone_number": "585-275-5875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHOUTHAVONG",
        "first_name": "KATHERINE",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-06",
        "last_updated": "2016-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "341143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nanette D Phillis, MD, PLLC, MD
• Henry Kaufman Philofsky
• Deloris J Phipps, LPN
• Kayia Phipps
• Chittadaphone Phouthavong, RN
• Chandra Phuyel, LPN
• Physical Medicine & Therapeutic Rehabilitation LLC
• Physical Therapy Associates of Rochester
• Physical Therapy of Rochester, LLC
• Physical Therapy Services of Rochester PC

• Family Nurse Practitioner in Rochester, NY
• Providers in Rochester, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2016; 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.