KSN Primary Care LLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

Legal business name

KSN PRIMARY CARE LLC

Practice address

1841 Fairlawn Knolls Dr
Akron, OH 44313-5435

Phone

(330) 310-6812

Fax

(330) 776-5557

NPI assigned

Jan 13, 2025

Organization subpart

No

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

Authorized official

Name

Korto Sulongteh-NelsonNPI 1174956833

Title

Owner

Phone

(330) 310-6812

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Korto Sulongteh-Nelson, NURSE PRACTITIONER

  • Gerontology Nurse Practitioner
  • Cleveland, OH
  • NPI 1174956833
  Medicare reassignment NPD Authorized official
• David E Childs Jr.

  • Skilled Nursing Facility
  • Alliance, OH
  • NPI 1619211646
  NPD (past)

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

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1437969201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1841 FAIRLAWN KNOLLS DR",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443135435",
            "telephone_number": "330-310-6812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1841 FAIRLAWN KNOLLS DR",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443135435",
            "telephone_number": "330-310-6812",
            "fax_number": "330-776-5557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSN PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "SULONGTEH-NELSON",
        "authorized_official_first_name": "KORTO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-310-6812"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie A Krueger, LISW
• Caroline Jemma Kruithoff, DO
• Charles Edward Krumm III, DDS
• Kay Krych
• Marissa Rose Krzynowek
• Heather Marie Kubalek
• Janice Adrian Kubiak
• Justina Ashley Kubiak, D.O.
• Adriene Marie Kubic, CRNA
• Richard J. Kucera, APRN-CRNA

• Gerontology Nurse Practitioner in Akron, OH
• Providers in Akron, OH by specialty
• Gerontology Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.