Basic Information
| Provider Information | |||||||||
| NPI: | 1255837399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRYOR | ||||||||
| FirstName: | KORTNIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MS, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8110 ROYAL PALM BLVD STE 108 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330655742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543418288 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8100 ROYAL PALM BLVD STE 108 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330655733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543418288 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207VX0000X | ME157665 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207V00000X | 207V00000X | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.