Active NPI
Joel Kutnick, MD
- Psychiatry Physician
- Georgetown, TX
National Provider Identifier
1376534578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- E-0522
- Practice address
- 316 Independence Creek LN
Georgetown, TX 78633-5314 - Phone
- (361) 779-3009
- Fax
- (512) 869-5876
- NPI assigned
- Nov 4, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | E-0522 | TX | Primary |
Addresses
Primary practice location
316 Independence Creek LN
Georgetown, TX 78633-5314
Mailing address
316 Independence Creek LN
Georgetown, TX 78633-5314
Phone (361) 779-3009
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-0522 | TX | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265760000000",
"number": "1376534578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "316 INDEPENDENCE CREEK LN",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786335314",
"telephone_number": "361-779-3009",
"fax_number": "512-869-5876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "316 INDEPENDENCE CREEK LN",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786335314",
"telephone_number": "361-779-3009",
"fax_number": "512-869-5876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUTNICK",
"first_name": "JOEL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-04",
"last_updated": "2010-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "E-0522",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Georgetown, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.