Provider Demographics
NPI:1013648914
Name:PERRY, KORTNEE (RN)
Entity Type:Individual
Prefix:
First Name:KORTNEE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 BEATTIE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5642
Mailing Address - Country:US
Mailing Address - Phone:716-803-0126
Mailing Address - Fax:
Practice Address - Street 1:130 BEATTIE AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5023
Practice Address - Country:US
Practice Address - Phone:716-478-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY754884163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics