=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699614966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KODY LYNN NRP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2026
-----------------------------------------------------
Last Update Date | 03/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1620 BEECHVUE ST
-----------------------------------------------------
City | BUENA VISTA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15018-9517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-208-8496
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 E NORTH AVE STE 0
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15212-4756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-359-3131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | 215564
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------