Active NPI
Collette Marie Evrard, NP
- Family Nurse Practitioner
- Portland, OR
National Provider Identifier
1184955940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 200650018NP
- Practice address
- 3710 SW US Veterans Hospital Rd
Portland, OR 97239-2964 - Phone
- (503) 721-7802
- NPI assigned
- Jan 19, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 200650018NP | OR | Primary |
Addresses
Primary practice location
3710 SW US Veterans Hospital Rd
Portland, OR 97239-2964
Mailing address
22605 S Estacada Rd
Estacada, OR 97023-9670
Phone (503) 545-7635
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141202001534 | OR | Order and Referring Only - Nurse Practitioner | 1153643150 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200650018NP | OR | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263859200000",
"number": "1184955940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22605 S ESTACADA RD",
"city": "ESTACADA",
"state": "OR",
"postal_code": "970239670",
"telephone_number": "503-545-7635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3710 SW US VETERANS HOSPITAL RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392964",
"telephone_number": "503-721-7802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVRARD",
"first_name": "COLLETTE",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-01-19",
"last_updated": "2010-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OR",
"license": "200650018NP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.