Visana Wellness, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

200250089NP Issued in OR

Legal business name

VISANA WELLNESS, LLC

Practice address

603 Hemlock Street
3B
Brookings, OR 97415-9999

Phone

(541) 469-9100

Fax

(541) 469-9200

NPI assigned

Dec 5, 2008

Last updated

Dec 5, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Tracey Stephen Kather, FNPNPI 1861538274

Title

Owner

Phone

(541) 251-1010

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tracey S Kather, NP

  • Family Nurse Practitioner
  • Brookings, OR
  • NPI 1861538274
  Medicare reassignment NPD Authorized official
• Robert Tovey Johnson, DC

  • Chiropractor
  • Brookings, OR
  • NPI 1891792131
  NPD

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

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228435200000",
    "number": "1427293349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6945",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974150353",
            "telephone_number": "541-469-9100",
            "fax_number": "541-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 HEMLOCK STREET",
            "address_2": "3B",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974159999",
            "telephone_number": "541-469-9100",
            "fax_number": "541-469-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISANA WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-05",
        "last_updated": "2008-12-05",
        "status": "A",
        "authorized_official_last_name": "KATHER",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-251-1010",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OR",
            "license": "200250089NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Anne Van Maren, CPM, LDM, LM, THW
• Krystal Van Pelt
• Brandi Vanmeter, L.AC.
• Ricky Vanrheenen
• Vincent Van Houten, O.D., PC
• Amy Ray Vossler
• Donald William Walker, MBA, FNP-C, GNP
• Douglas John Walker, O.D.
• Warren J Krick MD PC
• Nicole Watkins-Murphy

• Primary Care Clinic/Center in Brookings, OR
• Providers in Brookings, OR by specialty
• Primary Care Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.