Kelly Ann Nickerson, RN, BSN
Individual provider Active NPI Addiction (Substance Use Disorder) Registered Nurse · Damascus, OR
NPI 1235969742 · NPPES record last updated Aug 7, 2024
Key facts
- NPI
- 1235969742
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Registered Nurse 163WA0400X
- License
- 201142980RN (OR)
- Practice address
- 15758 SE Highway 224 Unit 96
Damascus, OR 97089-8410 - Phone
- (503) 421-8226
- NPI assigned
- Aug 7, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201142980RN | OR | MD | Addiction (Substance Use Disorder) Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Registered Nurse | 163WA0400X | 201142980RN | OR | Yes |
Addresses
Primary practice location
15758 SE Highway 224 Unit 96
Damascus, OR 97089-8410
Mailing address
15758 SE Highway 224 Unit 96
Damascus, OR 97089-8410
Phone (503) 421-8226
Other providers in Damascus, OR
- Mari Ann Mains
- Caitlin Maxson
- Angela Lynn McGinley
- Shalaine Joy Mistretta
- Morris Sarriugarte DMD, PC
- Malisa Norton
- Laura Jo Oconnor
- Rachel Panetta
- Jennifer Lynn Payne
- Juliette Reine Pierce
All providers in Damascus, OR · Addiction (Substance Use Disorder) Registered Nurse in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.