Provider Demographics
NPI:1598048985
Name:KORT, CARRIE (RN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:KORT
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 1:3810 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8134
Mailing Address - Country:US
Mailing Address - Phone:308-237-5951
Mailing Address - Fax:308-234-4018
Practice Address - Street 1:835 S BURLINGTON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6960
Practice Address - Country:US
Practice Address - Phone:402-462-4200
Practice Address - Fax:402-462-4201
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE56817163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse