Poppy Jean Cogburn, RN

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

RN00160337 Issued in WA

Practice address

516 E 1St St
Aberdeen, WA 98520-4106

Phone

(360) 721-3591

NPI assigned

Jul 23, 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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1396318606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 WESTPORT RD",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985206444",
            "telephone_number": "360-593-9013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 E 1ST ST",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985204106",
            "telephone_number": "360-721-3591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COGBURN",
        "first_name": "POPPY",
        "middle_name": "JEAN",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-23",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "RN00160337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE LICENSURE",
            "identifier": "RN00160337",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.acadiahealthcare.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "516 E 1st St",
            "city": "Aberdeen",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985204106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Registered Nurse in Aberdeen, WA
• Providers in Aberdeen, WA by specialty
• Addiction (Substance Use Disorder) Registered Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.