Active NPI
Kywana Renee Corbett, LRT, CTRS
- Recreation Therapist
- Wake Forest, NC
National Provider Identifier
1073362612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 4620
- Practice address
- 2400 Alstonburg Ave # a
Wake Forest, NC 27587-9384 - Phone
- (910) 515-3492
- NPI assigned
- May 15, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 4620 | NC | Primary |
Addresses
Primary practice location
2400 Alstonburg Ave # a
Wake Forest, NC 27587-9384
Mailing address
2400 Alstonburg Ave # a
Wake Forest, NC 27587-9384
Phone (910) 515-3492
Other names 1
- Kywana Renee Corbett
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4620 | NC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heartbeat RT-LLC | Recreation Therapist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Recreation Therapist
- Wake Forest, NC
- NPI 1306686357
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1073362612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 ALSTONBURG AVE # A",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275879384",
"telephone_number": "910-515-3492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 ALSTONBURG AVE # A",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275879384",
"telephone_number": "910-515-3492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORBETT",
"first_name": "KYWANA",
"middle_name": "RENEE",
"credential": "LRT, CTRS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-15",
"last_updated": "2024-05-15",
"certification_date": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "NC",
"license": "4620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KYWANA",
"last_name": "CORBETT",
"middle_name": "RENEE",
"credential": "LRT, CTRS",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Wake Forest, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.