Kourtney Jevon Royster

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A19887 Issued in NC

Practice address

610 Durham St
Burlington, NC 27217-2306

Phone

(336) 501-6067

NPI assigned

May 13, 2024

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Empirical Wellness Center

  • Nurse Practitioner
  • Burlington, NC
  • NPI 1053022988
  NPD (past)

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

{
    "created_epoch": "1715558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1093563108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 DURHAM ST",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272172306",
            "telephone_number": "336-265-6108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 DURHAM ST",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272172306",
            "telephone_number": "336-501-6067"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2929 Crouse Ln Ste E",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "NC",
            "postal_code": "272158317",
            "country_code": "US",
            "telephone_number": "336-567-4033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROYSTER",
        "first_name": "KOURTNEY",
        "middle_name": "JEVON",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-05-13",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A19887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip John Rosenow, MD
• Roslyn M. Crisp DD, Ms, PA
• Kendra Lynn Rost, DPT
• Sarah Starnes Rouse, MS, RD, LDN
• Debra Royster
• Jessica Anna Rubio, FNP
• Lyndee Ruddell
• Colleen Henderson Russell, RD
• James Scott Russell, MPT
• Steven Michael Russo, D.O.

• Mental Health Counselor in Burlington, NC
• Providers in Burlington, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.

Verify at the official NPI Registry.