Edisa Korac, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F402814-01 Issued in NY

Practice address

10 Pearl St
Port Chester, NY 10573-4611

Phone

(845) 279-5908

NPI assigned

Jan 12, 2023

Last updated

Jan 12, 2023By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Carmel Psychological Health, PC

  dba LifeStance Psychology

  • Psychologist
  • Carmel, NY
  • NPI 1720194335
  NPD (past)

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

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1689388720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 SOUTH RD APT 2Y",
            "city": "HARRISON",
            "state": "NY",
            "postal_code": "105283337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 PEARL ST",
            "city": "PORT CHESTER",
            "state": "NY",
            "postal_code": "105734611",
            "telephone_number": "845-279-5908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORAC",
        "first_name": "EDISA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-12",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F402814-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mohammed Naeem Khan, PHARM.D.
• Joseph R Kiefer, MPT
• Toni Marie King, M.S., L. AC.
• Joan Koenig, NP
• Ava Konwiser, RN
• Taylor Janelle Kordich, OTR/L
• Krystyna Kosicki, D.D.S.
• Alyssa L. Kreider, PMHNP-BC
• L B Dental P. C.
• Patricia Labrunda, O.D

• Psychiatric/Mental Health Nurse Practitioner in Port Chester, NY
• Providers in Port Chester, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.