Individual provider Active NPI

Kourtney Alexandra Gwin, DO

  • General Practice Physician
  • San Antonio, TX
National Provider Identifier
1316790603
Registry record updated Mar 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
0102209973 Issued in VA
Practice address
3551 Roger Brooke Dr
San Antonio, TX 78234-4504
Phone
(916) 757-7470
NPI assigned
Apr 8, 2024
Last updated
Mar 2, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 0102209973 VA Primary
Military Health Care Provider 171000000X BP10090843 TX

Addresses

Primary practice location

3551 Roger Brooke Dr
San Antonio, TX 78234-4504

Mailing address

8019 Indian Creek Dr
Orangevale, CA 95662-2140
Phone (916) 757-7470

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20260616000123 VA Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 1355813973

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
BP10090843TXMDMilitary Health Care Provider
0102209973VAMDGeneral Practice Physician

NPI Registry JSON

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772409600000",
    "number": "1316790603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8019 INDIAN CREEK DR",
            "city": "ORANGEVALE",
            "state": "CA",
            "postal_code": "956622140",
            "telephone_number": "916-757-7470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "916-757-7470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWIN",
        "first_name": "KOURTNEY",
        "middle_name": "ALEXANDRA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-08",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0102209973",
            "primary": true
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "TX",
            "license": "BP10090843",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.