Kortney Jo Koterass
Individual provider Active NPI Licensed Practical Nurse · Kennedy, NY
NPI 1457052813 · NPPES record last updated Mar 13, 2023
Key facts
- NPI
- 1457052813
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 344872-01 (NY)
- Practice address
- 24B Blue Jay St
Kennedy, NY 14747-9549 - Phone
- (716) 490-5282
- NPI assigned
- Mar 13, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 344872-01 | NY | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 344872-01 | NY | Yes |
Addresses
Primary practice location
24B Blue Jay St
Kennedy, NY 14747-9549
Mailing address
24B Blue Jay St
Kennedy, NY 14747-9549
Phone (716) 490-5282
Other providers in Kennedy, NY
All providers in Kennedy, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.