Individual provider Active NPI

Kelsey Breanne Koukol, CNA

  • Home Health Aide
  • Kennewick, WA
National Provider Identifier
1467224709
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AideTaxonomy code 374U00000X
License
NC60461107 Issued in WA
Practice address
8819 W Victoria Ave
Kennewick, WA 99336-7193
Phone
(509) 783-1851
NPI assigned
Oct 30, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Aide 374U00000X NC60461107 WA Primary

Addresses

Primary practice location

8819 W Victoria Ave
Kennewick, WA 99336-7193

Mailing address

8819 W Victoria Ave
Kennewick, WA 99336-7193
Phone (509) 783-1851

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
NC60461107WAMDHome Health Aide

NPI Registry JSON

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

{
    "created_epoch": "1698624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1467224709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8819 W VICTORIA AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367193",
            "telephone_number": "509-783-1851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8819 W VICTORIA AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367193",
            "telephone_number": "509-783-1851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUKOL",
        "first_name": "KELSEY",
        "middle_name": "BREANNE",
        "credential": "CNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-30",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "WA",
            "license": "NC60461107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennewick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.