Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Annie Kathryn Kornetzke, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1053979948

Annie Kathryn Kornetzke, DO is a Family Practice in Taylorsville, Utah. Graduated from Chicago College of Osteopathy in 2019, 7 years ago. Practices with Community Health Centers Inc, a 39-clinician group and accepts Medicare assignment. Licensed in Illinois and Utah.

Years since qualifying
7
Trained at
Chicago College of Osteopathy
Licensed in
IL, UT
In the registry since
2019
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

4745 S 3200 W
Taylorsville, UT 84129-2822
Phone: (801) 964-6214
Fax: (877) 497-4661
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 12784879-1204 (UT)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence 125074527 (IL)

Record details

NPI number1053979948
Entity typeIndividual (Type 1)
GenderFemale
Credentials DO
Sole proprietorNo
NPI enumeratedJune 5, 2019
Last updated in NPPESJuly 19, 2022
Certification dateJuly 19, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolCHICAGO COLLEGE OF OSTEOPATHY
Graduated 2019 (7 years in practice)
Group practice Community Health Centers Inc — 39 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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