AGEWELL GERIATRICS, LLC (NPI# 1225698889) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225698889 |
| Entity Type | Organization |
| Organization Name | AGEWELL GERIATRICS, LLC |
| Practice Address |
13120 Sw Heather Ct Beaverton OR 97008-5612 |
| Practice Telephone | 5037803708 |
| Practice Fax Number | 5036393870 |
| Mailing Telephone | 5037803708 |
| Mailing Fax Number | 5036393870 |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-06-17 |
| Authorized Official Name | RENEE LADENE REED (OWNER/NURSE PRACTITIONER) |
| Authorized Official Telephone | 5037803708 |
| Authorized Official Credential | ANP-C, GNP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NPI | 1154613941 | 01 | |
| OR | 500698230 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | AGEWELL GERIATRICS, LLC | 13120 Sw Heather Court, Beaverton, OR 97008 |
| Street Address |
13120 SW HEATHER CT |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97008-5612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972136638 | Kelly Mitchell | Counselor | 6600 Sw 105th Ave Suite 120, Beaverton, OR 97008 | 2020-02-20 |
| 1700305315 | Heather Denise Glenn | Counselor | 6700 Sw 105th Avenue, Suite 203, Beaverton, OR 97008 | 2017-09-14 |
| 1649798265 | Timothy Wilkins | Counselor | 8285 Sw Nimbus Ave #148, Beaverton, OR 97008 | 2017-09-04 |
| 1962920751 | West End Surgical, LLC | Clinic/Center | 9405 Sw Nimbus Ave, Beaverton, OR 97008 | 2017-09-01 |
| 1073054714 | University Professional Services | Durable Medical Equipment & Medical Supplies | 9317 Sw Nimbus Ave, Beaverton, OR 97008 | 2017-03-14 |
| 1508311424 | Mitra Gaspeed | Dental Hygienist | 8615 Sw Thoroughbred Pl., Beaverton, OR 97008 | 2016-08-20 |
| 1740521988 | Donna Louise Grenier | Registered Nurse | 1413 E St, Independence, OR 97008 | 2013-03-13 |
| 1508105735 | Mary Elizabeth Smith | Specialist/Technologist, Other | 11855sw Ridgecrest Dr, #209, Beaverton, OR 97008 | 2013-02-07 |
| 1629315551 | Adelfino J Zuriaga | Massage Therapist | 11985 Sw Camden Ln, Beaverton, OR 97008 | 2013-01-11 |
| 1760738330 | Lih-wern Wang | Pharmacist | 9775 Sw Gemini Dr Ste 1, Beaverton, OR 97008 | 2012-07-31 |
| Find all providers in zip 97008 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972073807 | Jenna M Mccummings | Nurse Practitioner | 439 S Ross St, Beaverton, MI 48612-9101 | 2018-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154956233 | Ellen Faye Barlow | Nurse Practitioner | 506 Fourth St., La Grande, OR 97850 | 2020-03-09 |
| 1760960462 | Sid Christian Keomanivong | Nurse Practitioner | 2677 Beall Ln, Central Point, OR 97502-1462 | 2018-08-03 |
| 1245611771 | Karen Musick | Nurse Practitioner | 3514 Nw Mckinley Dr, Corvallis, OR 97330-1148 | 2015-06-10 |
| 1184054546 | Nancy M Burgess Rn Msn Anp-c PC | Nurse Practitioner | 910 Sw Highway 97 Ste 104, Madras, OR 97741-9247 | 2013-11-22 |
| 1518391804 | Sally Elizabeth Kraynik | Nurse Practitioner | 1895 E Main St, Hillsboro, OR 97123-4345 | 2013-08-22 |
| 1295998920 | Paula Jo Cramer | Nurse Practitioner | 790 S Main St Myrtle, Creek, Ore, Myrtle Creek, OR 97457 | 2008-07-02 |
| 1780855601 | Leslie West | Nurse Practitioner | 51730 Dexter St., Blue River, OR 97413-0183 | 2008-03-19 |
| 1548399322 | Corporate Health Nw | Nurse Practitioner | 10209 Se Division St, Portland, OR 97266-1327 | 2007-03-05 |
| 1962540310 | Laura Ann Shattuck | Nurse Practitioner | 21440 S Upper Highland Rd, Beavercreek, OR 97004-8814 | 2007-02-01 |
| 1699761932 | Rogue Valley Physicians | Nurse Practitioner | 2900 Doctors Park Dr, Medford, OR 97504-8127 | 2005-09-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.