KELLY EILEEN CHURCH (NPI# 1598309387) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1598309387 |
Entity Type | Individual |
Full Name | KELLY EILEEN CHURCH |
Credential | FNP |
Practice Address |
910 S Central Ave Medford OR 97501-7822 |
Mailing Address |
931 Chevy Way Medford OR 97504-4127 |
Practice Telephone | 5416181380 |
Mailing Telephone | 5416903555 |
Enumeration Date | 2019-11-05 |
Last Update Date | 2020-07-02 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 163WC0200X |
Registered Nurse Specialization: Critical Care Medicine |
201390291RN | OR | Nursing Service Providers |
Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
202000541NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
Address | Telephone Number | Fax Number |
---|---|---|
415 Greenbrae Dr, Medford, OR 975048140 | 5416597316 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205023389 | Kelly Ann Church | Internal Medicine | 800 Zorn Ave, Geriatrics and Extended Care, Va Medical Center, Louisville, KY 40206-1433 | 2007-10-02 |
Street Address |
910 S CENTRAL AVE |
City | MEDFORD |
State | OR |
Zip Code | 97501-7822 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1215127519 | Hillary Lynn Handelsman | Nurse Practitioner | 910 S Central Ave, Medford, OR 97501-7822 | 2007-08-01 |
1215568704 | Erica Davoren | Registered Nurse | 910 S Central Ave, Medford, OR 97501-7822 | 2020-02-03 |
1245860048 | La Clinica Del Valle Family Healthcare Center Inc. | Internal Medicine | 910 S Central Ave, Medford, OR 97501-7822 | 2020-01-21 |
1184114696 | Judith Mackey | Nurse Practitioner | 910 S Central Ave, Medford, OR 97501-7822 | 2018-05-10 |
1366892598 | Peter Michael Millard | Nurse Practitioner | 910 S Central Ave, Medford, OR 97501-7822 | 2016-06-19 |
1346695236 | Nathaniel Fondell | Family Medicine | 910 S Central Ave, Medford, OR 97501-7822 | 2016-04-27 |
1821488875 | Dora Hebe Best | Counselor | 910 S Central Ave, Medford, OR 97501-7822 | 2015-01-29 |
1417372731 | La Clinica Del Valle Family Health Care Center Inc | Clinic/Center | 910 S Central Ave, Medford, OR 97501-7822 | 2014-02-24 |
1790108702 | Julianne T Curl | Nurse Practitioner | 910 S Central Ave, Medford, OR 97501-7822 | 2014-01-27 |
1063737252 | Laurel M Brown | Physician Assistant | 910 S Central Ave, Medford, OR 97501-7822 | 2010-03-31 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1366069494 | Brian Snapp | Counselor | 1191 Hazel St, Medford, OR 97501 | 2020-07-06 |
1477174761 | Corey Renfree | Counselor | 1191 Hazel Street, Medford, OR 97501 | 2020-04-28 |
1669012928 | One of A Kind Therapy LLC | Social Worker | 916 West 10th St #205, Medford, OR 97501 | 2020-01-14 |
1265993620 | Star Dialysis LLC | Clinic/Center | 50 Rossanley Dr, Medford, OR 97501 | 2019-03-28 |
1962972463 | Karen Elise Roertgen | Counselor | 328 So. Central Ave., Suite 204, Medford, OR 97501 | 2018-11-28 |
1316458813 | Rick's Medical Supply, Inc | Durable Medical Equipment & Medical Supplies | 562 Parsons Drive, Suite 114, Medford, OR 97501 | 2017-10-24 |
1750807111 | La Clinica Del Valle Family Health Care Center Inc. | Clinic/Center | 821 N Riverside Ave, Medford, OR 97501 | 2017-08-17 |
1992229009 | Cassandra Schultz | Massage Therapist | 824 East Jackson, Suite A, Medford, OR 97501 | 2017-07-31 |
1972962355 | Robin Clevenger | Peer Specialist | 301 S Ivy St, Medford, OR 97501 | 2016-02-15 |
1154706984 | Debbie Diane Orr | Behavioral Analyst | 1024 West 9th Street, Medford, OR 97501 | 2015-07-22 |
Find all providers in zip 97501 |
Taxonomy Code | 363LF0000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Family |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1679113922 | Elena Chapman | Nurse Practitioner | 293 Salem St 4, Medford, MA 02155 | 2020-01-14 |
1770005407 | Suzanne Ellen Sanderson | Nurse Practitioner | 2620 E Barnett Rd Ste H, Medford, OR 97504-8383 | 2017-07-14 |
1194189902 | Josephine Magpantay Gaviola | Nurse Practitioner | 101 Main St Ste 116, Medford, MA 02155-4530 | 2016-04-07 |
1033514286 | Lauren E Hodgdon | Nurse Practitioner | 1698 E Mcandrews Rd Ste 200, Medford, OR 97504 | 2014-10-30 |
1962820209 | Jessica Anne Marie Gunn | Nurse Practitioner | 21 Ohio Trl, Medford, NJ 08055-8931 | 2014-04-03 |
1912333451 | Travis Adam Day | Nurse Practitioner | 70 Bower Dr Ste 110, Medford, OR 97501-3689 | 2013-09-16 |
1184058703 | Ashley Riley | Nurse Practitioner | 101 Main St Ste 107, Medford, MA 02155-4530 | 2013-08-30 |
1578841169 | Shannon Jamerson | Nurse Practitioner | 619 N Front St, Medford, OK 73759-2704 | 2011-07-29 |
1891081113 | Debra Jeanne Zenner | Nurse Practitioner | 143 South Gibson St., Medford, WI 54451 | 2011-06-24 |
1366763336 | Edward William Walton | Nurse Practitioner | 2 Pinecrest Dr, Medford, NJ 08055-8513 | 2010-06-14 |
Find all providers in MEDFORD |
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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.