Provider Demographics
NPI:1942680053
Name:KORTH, KAMI LEIGH
Entity Type:Individual
Prefix:
First Name:KAMI
Middle Name:LEIGH
Last Name:KORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WEST 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153
Mailing Address - Country:US
Mailing Address - Phone:308-284-6767
Mailing Address - Fax:308-284-3084
Practice Address - Street 1:401 WEST 1ST STREET
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153
Practice Address - Country:US
Practice Address - Phone:308-284-6767
Practice Address - Fax:308-284-6767
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator