Healthcare Provider Details

I. General information

NPI: 1023778073
Provider Name (Legal Business Name): PAULA KORT KOMMOR MED, NBC-HWC, ACC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 N KEATS AVE APT 2
LOUISVILLE KY
40206-2494
US

IV. Provider business mailing address

173 N KEATS AVE APT 2
LOUISVILLE KY
40206-2494
US

V. Phone/Fax

Practice location:
  • Phone: 502-819-8005
  • Fax:
Mailing address:
  • Phone: 502-819-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number77589992
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: