Provider Demographics
NPI:1669459335
Name:KORTYNA, PRISCILLA (CRNA)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:KORTYNA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:14
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:325-670-4220
Mailing Address - Fax:325-670-4040
Practice Address - Street 1:1900 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2432
Practice Address - Country:US
Practice Address - Phone:325-670-4220
Practice Address - Fax:325-670-4040
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX509048163W00000X
OHRN-224995163W00000X
TX38907367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11990281Medicaid
TX8L11637Medicare PIN
430027406OtherRAILROAD MEDICARE
TX119902801Medicaid
TX88628COtherBLUE CROSS PROVIDER ID
TX8D2868Medicare PIN