Komkwuan Pholtavee Paruchabutr, WHNP-BC, FNP-BC, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

Practice address

9600 Dewitt Loop
Fort Belvoir, VA 22060

Phone

(703) 424-5112

NPI assigned

Dec 1, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

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

{
    "created_epoch": "1291161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1689976367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 PATRICK ST SW",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221806740",
            "telephone_number": "703-424-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 DEWITT LOOP",
            "city": "FORT BELVOIR",
            "state": "VA",
            "postal_code": "22060",
            "telephone_number": "703-424-5112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Building 4-2817 Reilly Road",
            "address_purpose": "LOCATION",
            "city": "Fort Bragg",
            "state": "NC",
            "postal_code": "28307",
            "country_code": "US",
            "telephone_number": "910-907-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARUCHABUTR",
        "first_name": "KOMKWUAN",
        "middle_name": "PHOLTAVEE",
        "name_prefix": "Mrs.",
        "credential": "WHNP-BC, FNP-BC, CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-01",
        "last_updated": "2021-05-10",
        "certification_date": "2021-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WW0101X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Women's Health Care, Ambulatory",
            "state": "NC",
            "license": "207275",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Parker, PSY.D.
• Mary Katherine Parker, ANP-BC
• Leah Marie Parsons, OTR/L
• Michael Edward Parsons, MD
• Douglas Matthew Partanen, PHYSCIAN ASSISTANT
• Zoey Neudeck Pascual, DO
• Neha H Patel, PHARM.D.
• Shimul Shah Patel, MD
• Urvi Patel, PHARM D
• Kasi Gabriel Patterson, PH.D.

• Advanced Practice Midwife in Fort Belvoir, VA
• Providers in Fort Belvoir, VA by specialty
• Advanced Practice Midwife in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; 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.