1023778073 NPI number — MS. PAULA KORT KOMMOR MED, NBC-HWC, ACC

Table of content: MS. PAULA KORT KOMMOR MED, NBC-HWC, ACC (NPI 1023778073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023778073 NPI number — MS. PAULA KORT KOMMOR MED, NBC-HWC, ACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOMMOR
Provider First Name:
PAULA
Provider Middle Name:
KORT
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MED, NBC-HWC, ACC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023778073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
173 N KEATS AVE APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40206-2494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-819-8005
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
173 N KEATS AVE APT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40206-2494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-819-8005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171400000X , with the licence number:  77589992 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com