Alexis Komornik, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

5015620 Issued in NC

Practice address

3411 Graystone PL SE
Conover, NC 28613-8200

Phone

(828) 328-1118

Fax

(828) 328-1119

NPI assigned

Jan 19, 2022

Sex

Female

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 SC

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

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alexis.komornik.1@1152.direct.athenahealth.com
• Direct secure messaging: akomornik523807@direct.musc.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Family Care, Inc

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1184655722
  Medicare reassignment NPD
• Carolina Family Care, Inc

  • Pediatrics Physician
  • Charleston, SC
  • NPI 1003846783
  NPD
• Unifour Pediatrics, PA

  • Pediatrics Physician
  • Conover, NC
  • NPI 1770782450
  NPD (past)
• Carolina Family Care, Inc

  • Pediatrics Physician
  • Charleston, SC
  • NPI 1750318101
  NPD (past)
• Coastal Pediatric Associates, P.a.

  • Pediatrics Physician
  • Charleston, SC
  • NPI 1770700759
  NPD (past)

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

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1679225841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3411 GRAYSTONE PL SE",
            "city": "CONOVER",
            "state": "NC",
            "postal_code": "286138200",
            "telephone_number": "828-328-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3411 GRAYSTONE PL SE",
            "city": "CONOVER",
            "state": "NC",
            "postal_code": "286138200",
            "telephone_number": "828-328-1118",
            "fax_number": "828-328-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMORNIK",
        "first_name": "ALEXIS",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-19",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5015620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Millicent Kaufman, PHD, RN, APRN
• Kevin E. Brown, DMD, Ms, PA
• Tou Shonpov Khang, RPH
• Michelle Lynn Kirby, R.PH, CMF
• Lauren Ann Kiziah, PHARMD
• Anastasia Cherie Elizabeth Kosiske, MD
• Alexander John Krisko, DMD, MD
• Samantha Lackey
• Carol Lands, PA
• Thomas F Laney Jr., MD

• Pediatric Nurse Practitioner in Conover, NC
• Providers in Conover, NC by specialty
• Pediatric Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; 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.