SID CHRISTIAN KEOMANIVONG (NPI# 1760960462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760960462 |
| Entity Type | Individual |
| Full Name | SID CHRISTIAN KEOMANIVONG |
| Practice Address |
2677 Beall Ln Central Point OR 97502-1462 |
| Mailing Address |
3344 Winterhaven St Unit 101 Las Vegas NV 89108-5064 |
| Practice Telephone | 7023430466 |
| Mailing Telephone | 7023430466 |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2019-10-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
201806379NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2677 BEALL LN |
| City | CENTRAL POINT |
| State | OR |
| Zip Code | 97502-1462 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013459734 | Rebuilding Together Rogue Valley | Home Health | 421 Stone Pointe Drive, Central Point, OR 97502 | 2016-11-11 |
| 1801262431 | Kathleen Marie Vandevender | Behavioral Analyst | 153 Wind Song Drive, Central Point, OR 97502 | 2015-08-18 |
| 1356735112 | Nikole Mcewen | Behavioral Analyst | 2030 Taylor Rd, Central Point, OR 97502 | 2015-03-19 |
| 1619368636 | La Clinica Del Valle Family Health Care Center Inc. | Clinic/Center | 200 W Pine St, Central Point, OR 97502 | 2015-02-12 |
| 1124429360 | Sarah Jean North | Massage Therapist | 2463 Saint James Way, Central Point, OR 97502 | 2014-09-08 |
| 1972928034 | Jennifer Joe-anne Marks | Registered Nurse | 312 Oak St. Ste #205, Central Point, OR 97502 | 2014-02-26 |
| 1578991527 | Lawrence Gerald Whittington | Behavioral Analyst | 6340 Honey Tree Ln., Central Point, OR 97502 | 2013-10-29 |
| 1093141582 | Samuel Joseph Hicks | Behavioral Analyst | 4434 Corey Road, Central Point, OR 97502 | 2013-09-17 |
| 1598191074 | Kathie Ellen Moss | Behavioral Analyst | 5315 Teresa Way, Central Point, OR 97502 | 2013-09-17 |
| 1831525336 | Becky Kay Lunsford | Behavioral Analyst | 640 S. 2nd Street, Family Solutions, Central Point, OR 97502 | 2013-09-17 |
| Find all providers in zip 97502 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154956233 | Ellen Faye Barlow | Nurse Practitioner | 506 Fourth St., La Grande, OR 97850 | 2020-03-09 |
| 1225698889 | Agewell Geriatrics, LLC | Nurse Practitioner | 13120 Sw Heather Ct, Beaverton, OR 97008-5612 | 2019-06-17 |
| 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 | ||||
| City | CENTRAL POINT |
| Zip Code | 97502 |
Please comment or provide details below to improve the information on SID CHRISTIAN KEOMANIVONG.
| 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.