Active NPI
Kori L. Panico, NP
- Family Nurse Practitioner
- Bryan, OH
National Provider Identifier
1619109402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- COA10876-NP
- Practice address
- 500 W Mulberry St Ste 101
Bryan, OH 43506-1142 - Phone
- (419) 519-3336
- Fax
- (419) 212-9219
- NPI assigned
- Aug 13, 2009
- Last updated
- Oct 8, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | COA10876-NP | OH | Primary |
Addresses
Primary practice location
500 W Mulberry St Ste 101
Bryan, OH 43506-1142
Mailing address
500 W Mulberry St Ste 101
Bryan, OH 43506-1142
Phone (419) 519-3336
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2995399 | Medicaid | OH |
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
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA10876-NP | OH | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fauster Cameron Inc. | Past | Accepting new patients | |
| Comprehensive Health Care, Inc. | Past | Accepting new patients | |
| Everside Health, LLC | Past | Accepting new patients |
Interoperability endpoints
- kori.panico.1@14940.direct.athenahealth.com
- kori.panico.2@14940.direct.athenahealth.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Van Wert, OH
- NPI 1902079502
-
- Clinic/Center
- Bryan, OH
- NPI 1952834020
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728345600000",
"number": "1619109402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 W MULBERRY ST STE 101",
"city": "BRYAN",
"state": "OH",
"postal_code": "435061142",
"telephone_number": "419-519-3336",
"fax_number": "419-212-9219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 W MULBERRY ST STE 101",
"city": "BRYAN",
"state": "OH",
"postal_code": "435061142",
"telephone_number": "419-519-3336",
"fax_number": "419-212-9219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANICO",
"first_name": "KORI",
"middle_name": "L.",
"name_prefix": "Mrs.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-13",
"last_updated": "2024-10-08",
"certification_date": "2024-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OH",
"license": "COA10876-NP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2995399",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bryan, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.