Active NPI
Jerry Pearce Staton, RN
- Registered Nurse
- Newport, OR
National Provider Identifier
1366890444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 201603348RN
- Practice address
- 36 SW Nye St
Newport, OR 97365-3821 - Phone
- (541) 265-0581
- Fax
- (541) 574-6252
- NPI assigned
- May 30, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 201603348RN | OR | Primary |
Addresses
Primary practice location
36 SW Nye St
Newport, OR 97365-3821
Mailing address
2413 Conger Ave NW Unit B
Olympia, WA 98502-4507
Phone (360) 539-7365
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201603348RN | Other | OR | RN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201603348RN | OR | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464566400000",
"number": "1366890444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2413 CONGER AVE NW UNIT B",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985024507",
"telephone_number": "360-539-7365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 SW NYE ST",
"city": "NEWPORT",
"state": "OR",
"postal_code": "973653821",
"telephone_number": "541-265-0581",
"fax_number": "541-574-6252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STATON",
"first_name": "JERRY",
"middle_name": "PEARCE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-30",
"last_updated": "2016-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OR",
"license": "201603348RN",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN",
"identifier": "201603348RN",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newport, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.