Kourtney Brackins, MD

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

1495 W Victoria St
San Bernardino, CA 92411-2638

Phone

(909) 888-9064

NPI assigned

Jul 9, 2024

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)

Not enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1912744848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16001 CHASE RD UNIT 98",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923365083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1495 W VICTORIA ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924112638",
            "telephone_number": "909-888-9064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKINS",
        "first_name": "KOURTNEY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-09",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda Jean Boyle, PMHNP-BC
• William T Boyle, PA-C
• Cynthia Guadalupe Boyzo Mejia
• Anooshirvan Bozorgmehr, DO
• Dominique Brackins
• Emily Ruth Bradford-Lewis, FNP
• Jahonna M Bradford
• Tammy Bradshaw
• Christina L. Brady
• Coretta Brady

• Community Health Worker in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.