Kordale Tre Bavor, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

61422757 Issued in WA

Practice address

10004 204TH Ave E Ste 1300
Bonney Lake, WA 98391-6537

Phone

(253) 848-8797

NPI assigned

Aug 28, 2020

Last updated

Aug 22, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Multicare Health System

  dba Multicare Neurological Surgery

  • Neurological Surgery Physician
  • Tacoma, WA
  • NPI 1497766638
  Medicare reassignment NPD
• Multicare Health System

  dba MultiCare Deaconess Retail Pharmacy

  • Community/Retail Pharmacy
  • Spokane, WA
  • NPI 1396594875
  NPD
• Multicare Health System

  dba Mary Bridge Tacoma

  • Pediatrics Physician
  • Tacoma, WA
  • NPI 1518913318
  NPD
• Fedelta Care Solutions

  dba Fedelta Home Care

  • In Home Supportive Care Agency
  • Seattle, WA
  • NPI 1710398508
  NPD (past)
• Multicare Health System

  dba Auburn MultiCare Clinic

  • Family Medicine Physician
  • Auburn, WA
  • NPI 1013969195
  NPD (past)

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

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1659984631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10004 204TH AVE E STE 1300",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916537",
            "telephone_number": "253-848-8797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 204TH AVE E STE 1300",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916537",
            "telephone_number": "253-848-8797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAVOR",
        "first_name": "KORDALE",
        "middle_name": "TRE",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-28",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WA",
            "license": "61422757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Susan Barrentine, PMHNP
• Lisa Lyn Barrientos-Haase, LMP
• Karen Victoria Barrier, NBC-HWC
• Syed Rehan Bashar, DDS
• Michaela Batalon, PA-C
• Krysta L Baxter, LMP
• David Nicholas Beaird, DPT
• Eva Beal
• Susan M Beardemphl, PT
• Helena Becker, D.M.D.

• Pediatric Nurse Practitioner in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Pediatric Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.