Look up the most recent NPI and PECOS records

Khatuna Kipiani

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

2015 Grand Concourse, Bronx, NY 10453-4303

PECOS Enrollment

Based on the most recent information from CMS, provider Khatuna Kipiani is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1104151554
Provider Type
Individual
Full Name
Kipiani, Khatuna
Title
Mrs.
Credential
NP

Gender
Female
Sole Proprietor
Yes
Enumeration Date
10/2/2009
Last Updated
12/28/2023

Contact Information

Practice Location

2015 Grand Concourse, Bronx, NY 10453-4303

(718) 583-7736

(718) 537-6180

Mailing Location

2626 Halperin Ave, Bronx, NY 10461-2631

(718) 618-0401

(347) 479-1303

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License F352869 New York

Khatuna Kipiani

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Speck Iglesias, Jose

Nwaoha, Nkechi

Yao, Yumeng

Scotton, Charlene Carolyn

Grun, Deborah

Adom, Yaw

Boutos, Ekaterini

Mathieu, Farah Eloise

Childs, Timothy A

Carew, Jacqueline C