Grace Kim Koo, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN218400 Issued in GA

Practice address

514 W Maple St Ste 306
Cumming, GA 30040-2420

Phone

(678) 455-9885

Fax

(678) 455-9885

NPI assigned

Mar 29, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

State licenses

Practice roles

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.

• Healthstat Onsite Clinic-Forsyth County

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • Cumming, GA
  • NPI 1750942132
  NPD (past)

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

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572912000000",
    "number": "1093058976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 W MAPLE ST",
            "address_2": "STE 306",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300402420",
            "telephone_number": "678-455-9882",
            "fax_number": "678-455-9885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 W MAPLE ST STE 306",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300402420",
            "telephone_number": "678-455-9885",
            "fax_number": "678-455-9885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2205 Pavilion Dr",
            "address_2": "Suite 310",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376604641",
            "country_code": "US",
            "telephone_number": "423-224-3900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOO",
        "first_name": "GRACE",
        "middle_name": "KIM",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-29",
        "last_updated": "2019-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024171736",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "18490",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN218400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helen Laurie Kochilas, AUD
• Anna Kolomitseva, LICENSED ND
• Jacqueline Komoroski, RN, IBCLC
• Kristina Konieczny
• Ansley Konkle, MS, CCC-SLP
• Jeanne L. Kopacka, PA
• Anna Kops
• Madhavi Kothapally
• Swachitha Kothapally, MD
• Alena Koval

• Family Nurse Practitioner in Cumming, GA
• Providers in Cumming, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; 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.