Active NPI
Kristie Lynn Komorowski, MS,CCC/SLP
- Nursing Facility/Intermediate Care Facility
- Bridgeport, WV
National Provider Identifier
1891034112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Facility/Intermediate Care Facility
- License
- SLP-0942
- Practice address
- 415 Benedum Dr
Bridgeport, WV 26330-1503 - Phone
- (304) 842-9887
- Fax
- (304) 842-9888
- NPI assigned
- Feb 6, 2013
- 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 |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | SLP-0942 | WV | Primary |
Addresses
Primary practice location
415 Benedum Dr
Bridgeport, WV 26330-1503
Mailing address
415 Benedum Dr
Bridgeport, WV 26330-1503
Phone (304) 842-9887
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0942 | WV | MD | Family Medicine Physician |
| SLP-0942 | WV | MD | Nursing Facility/Intermediate Care Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360108800000",
"number": "1891034112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 BENEDUM DR",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263301503",
"telephone_number": "304-842-9887",
"fax_number": "304-842-9888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 BENEDUM DR",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263301503",
"telephone_number": "304-842-9887",
"fax_number": "304-842-9888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMOROWSKI",
"first_name": "KRISTIE",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "MS,CCC/SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-02-06",
"last_updated": "2013-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "WV",
"license": "SLP-0942",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.