Teresa Wyatt Kodiak, APN-CNP, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

219010786 Issued in IL

Practice address

611 W Roosevelt Rd
Chicago, IL 60607-4911

Phone

(773) 570-3382

NPI assigned

Nov 13, 2013

Sex

Female

Sole proprietor

Yes

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)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1384300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490313600000",
    "number": "1902236912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606074911",
            "telephone_number": "773-570-3382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606074911",
            "telephone_number": "773-570-3382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODIAK",
        "first_name": "TERESA",
        "middle_name": "WYATT",
        "credential": "APN-CNP, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-13",
        "last_updated": "2017-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "219010786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Kocsuta, MD
• Konrad Richard Koczwara, P.T.
• Abhigna Kodali, M.D.
• Anita Kodali, MD
• Sileshini Kodali, BDS
• Allen Kodish, M.D.
• Varna Kumar Kodoth, MD
• Anuradha Koduri, M.D.
• Priyadarshini Koduri, M.D.
• Pramoda Koduru, M.D

• Family Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2017; 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.