Active NPI
Cory Killeen, APRN, FNP
- Nurse Practitioner
- Vancouver, WA
National Provider Identifier
1306525464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- AP61457036
- Practice address
- 12420 NW 36TH Ave
Vancouver, WA 98685-2225 - Phone
- (971) 203-2317
- Fax
- (800) 859-8601
- NPI assigned
- Jul 17, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AP61457036 | WA | Primary |
Addresses
Primary practice location
12420 NW 36TH Ave
Vancouver, WA 98685-2225
Mailing address
12420 NW 36TH Ave
Vancouver, WA 98685-2225
Phone (360) 694-3060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 13, 2026 through Jan 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP61457036 | WA | MD | Nurse Practitioner |
Interoperability endpoints
- cory.killeen.1@18317.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787616000000",
"number": "1306525464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12420 NW 36TH AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986852225",
"telephone_number": "360-694-3060",
"fax_number": "800-859-8601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12420 NW 36TH AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986852225",
"telephone_number": "971-203-2317",
"fax_number": "800-859-8601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILLEEN",
"first_name": "CORY",
"credential": "APRN, FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-17",
"last_updated": "2026-08-25",
"certification_date": "2026-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WA",
"license": "AP61457036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.