Individual provider Active NPI

Katherine Ariel Bond, LPN

  • Licensed Practical Nurse
  • Port Jefferson Station, NY
National Provider Identifier
1457497638
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
284703 Issued in NY
Practice address
460 Old Town Rd
Apt 5a
Port Jefferson Station, NY 11776-2200
Phone
(631) 456-1774
NPI assigned
Jan 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 284703 NY Primary

Addresses

Primary practice location

460 Old Town Rd
Apt 5a
Port Jefferson Station, NY 11776-2200

Mailing address

460 Old Town Rd
Apt 5a
Port Jefferson Station, NY 11776-2200
Phone (631) 456-1774

Other identifiers 1

IdentifierTypeStateIssuer
02769551MedicaidNY

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
284703NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1457497638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 OLD TOWN RD",
            "address_2": "APT 5A",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762200",
            "telephone_number": "631-456-1774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 OLD TOWN RD",
            "address_2": "APT 5A",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762200",
            "telephone_number": "631-456-1774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOND",
        "first_name": "KATHERINE",
        "middle_name": "ARIEL",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "284703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02769551",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.