Individual provider Active NPI

Lily Ann Rosete Corleto, ARNP

  • Gerontology Nurse Practitioner
  • Richland, WA
National Provider Identifier
1366280190
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
AP61572066 Issued in WA
Practice address
900 Stevens Dr Ste 101
Richland, WA 99352-3536
Phone
(509) 942-3163
Fax
(509) 943-5922
NPI assigned
Jul 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP61572066 WA
Gerontology Nurse Practitioner 363LG0600X AP61572066 WA Primary

Addresses

Primary practice location

900 Stevens Dr Ste 101
Richland, WA 99352-3536

Mailing address

550 Gage Blvd Ste 101
Richland, WA 99352-9532
Phone (509) 627-2983

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20240925003332 WA Practitioner - Nurse Practitioner 0244771632 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kadlec Regional Medical CenterGroup PAC ID 9739098617, 402 clinicians

Practice addresses (Care Compare)

900 Stevens Dr
Suite 101
Richland, WA 99352-3536
Phone (509) 942-3180

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP61572066WAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kadlec Regional Medical Center CurrentSince Sep 1, 2024 Accepting new patients
Kadlec Regional Medical Center CurrentSince Sep 1, 2024 Accepting new patients
Kadlec Regional Medical Center Current Accepting new patients

Locations

1135 Jadwin Ave
Richland, WA 99352
Phone (509) 942-3300

900 Stevens Dr
Ste 101
Richland, WA 99352
Phone (509) 942-3180

550 Gage Blvd
Ste 101
Richland, WA 99352

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1366280190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 GAGE BLVD STE 101",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993529532",
            "telephone_number": "509-627-2983",
            "fax_number": "509-627-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 STEVENS DR STE 101",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993523536",
            "telephone_number": "509-942-3163",
            "fax_number": "509-943-5922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORLETO",
        "first_name": "LILY ANN",
        "middle_name": "ROSETE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61572066",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WA",
            "license": "AP61572066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richland, WA

Sources for this page

Verify at the official NPI Registry.