Kelli Kay Broessel, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH-0018527 Issued in OR

Practice address

110 Beavercreek Rd Ste 102
Oregon City, OR 97045-4307

Phone

(971) 204-8424

Fax

(503) 946-3046

NPI assigned

Sep 9, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Genoa Healthcare LLC

  • Long Term Care Pharmacy
  • Oregon City, OR
  • NPI 1700242179
  NPD
• Genoa Healthcare LLC

  • Long Term Care Pharmacy
  • Brockton, MA
  • NPI 1992521512
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1336818681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2264 NE THORNCROFT DR APT 434",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971249030",
            "telephone_number": "517-930-0615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BEAVERCREEK RD STE 102",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970454307",
            "telephone_number": "971-204-8424",
            "fax_number": "503-946-3046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROESSEL",
        "first_name": "KELLI",
        "middle_name": "KAY",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "RPH-0018527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian W. Humble, D.D.S., M.S., P.C.
• Bridge to Home LLC
• Catherine Vail Bridge, LAC
• Kayla M Briggs, MS OTR/L
• Stephanie Diane Briggs
• Joline Shu Bronson, MD
• Danielle Brookshire
• Janie Brow
• Heather Mae Brown, MSW
• Jill Melissa Brown, LPTA

• Pharmacist in Oregon City, OR
• Providers in Oregon City, OR by specialty
• Pharmacist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.