Provider Demographics
NPI:1427668953
Name:OGGERO, KOURTNEY KAHLER (FNP)
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:KAHLER
Last Name:OGGERO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HIGHLAND GATE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4493
Mailing Address - Country:US
Mailing Address - Phone:832-567-0239
Mailing Address - Fax:
Practice Address - Street 1:441 CLAY ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3693
Practice Address - Country:US
Practice Address - Phone:423-247-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26899363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care