Provider Demographics
NPI:1144863804
Name:MAI, KORTNEY (RN)
Entity type:Individual
Prefix:
First Name:KORTNEY
Middle Name:
Last Name:MAI
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 1:891 UNION STATION PKWY APT 16324
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5260
Mailing Address - Country:US
Mailing Address - Phone:918-277-1983
Mailing Address - Fax:
Practice Address - Street 1:891 UNION STATION PKWY APT 16324
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5260
Practice Address - Country:US
Practice Address - Phone:918-277-1983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019025335163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics