Provider Demographics
NPI:1255837399
Name:PRYOR, KORTNIE A (MS, MD)
Entity Type:Individual
Prefix:
First Name:KORTNIE
Middle Name:A
Last Name:PRYOR
Suffix:
Gender:F
Credentials:MS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 ROYAL PALM BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5742
Mailing Address - Country:US
Mailing Address - Phone:954-341-8288
Mailing Address - Fax:
Practice Address - Street 1:8100 ROYAL PALM BLVD STE 108
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5733
Practice Address - Country:US
Practice Address - Phone:954-341-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME157665207VX0000X
FL207V00000X207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology