Active NPI
Kwan Southerland, LPN
- Home Health Agency
- Fresh Meadows, NY
National Provider Identifier
1871991117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 275433
- Practice address
- 67-02B 186TH Lane
Fresh Meadows, NY 11365 - Phone
- (347) 712-7965
- NPI assigned
- Dec 19, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 275433 | NY | Primary |
Addresses
Primary practice location
67-02B 186TH Lane
Fresh Meadows, NY 11365
Mailing address
67-02B 186TH Lane
Apt 2C
Fresh Meadows, NY 11365
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 275433 | NY | MD | Home Health Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418947200000",
"number": "1871991117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "67-02B 186TH LANE",
"address_2": "APT 2C",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "11365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67-02B 186TH LANE",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "11365",
"telephone_number": "347-712-7965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHERLAND",
"first_name": "KWAN",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-19",
"last_updated": "2014-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "NY",
"license": "275433",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresh Meadows, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.