Kelli Jo Scott, LAC – Acupuncturist in Damascus, OR

Key facts

NPI: 1306285028
Entity type: Individual (NPI type 1)
Primary specialty: Acupuncturist 171100000X
License: 160456 (OR)
Practice address: 15691 SE Royer Rd
Damascus, OR 97089-2642
Phone: (503) 658-7715
Fax: (503) 658-7181
NPI assigned: Jun 15, 2013
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
H3109	OR	MD	Dental Hygienist
160456	OR	MD	Acupuncturist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dental Hygienist	124Q00000X	H3109	OR
Acupuncturist	171100000X	160456	OR	Yes

Addresses

Primary practice location

15691 SE Royer Rd
Damascus, OR 97089-2642

Mailing address

3028 SE 28TH Ave
Portland, OR 97202-2003

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 15, 2013.

{
    "created_epoch": "1371254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371254400000",
    "number": "1306285028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3028 SE 28TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972022003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15691 SE ROYER RD",
            "city": "DAMASCUS",
            "state": "OR",
            "postal_code": "970892642",
            "telephone_number": "503-658-7715",
            "fax_number": "503-658-7181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "KELLI",
        "middle_name": "JO",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-15",
        "last_updated": "2013-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "OR",
            "license": "H3109",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "160456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Damascus, OR

All providers in Damascus, OR · Acupuncturist in Oregon

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2013. 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.

Verify at the official NPI Registry.