Kerrin Deann Swanson, CPNP-PC

Key facts

NPI

1447725403

Entity type

Individual (NPI type 1)

Primary specialty

Pediatric Nurse Practitioner 363LP0200X

License

201810071NP-PP (OR)

Practice address

38505 Brooten Rd
Pacific City, OR 97135-8049

Phone

(503) 965-6555

NPI assigned

Oct 5, 2018

Sex

Female

Sole proprietor

No

Organizations & group practices 3

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.

• Northwest Medical Foundation of Tillamook Critical Access Hospital · Tillamook, OR · NPI 1871575225
  Medicare reassignment NPD OR
• Northwest Medical Foundation of Tillamook Critical Access Hospital · Sheridan, OR · NPI 1053873919
  NPD
• Northwest Medical Foundation of Tillamook Rural Health Clinic/Center · Tillamook, OR · NPI 1326349416
  NPD

Medicare participation

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 6, 2018.

{
    "created_epoch": "1538697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541462400000",
    "number": "1447725403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 3RD ST",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971413430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38505 BROOTEN RD",
            "city": "PACIFIC CITY",
            "state": "OR",
            "postal_code": "971358049",
            "telephone_number": "503-965-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWANSON",
        "first_name": "KERRIN",
        "middle_name": "DEANN",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-05",
        "last_updated": "2018-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OR",
            "license": "201810071NP-PP",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201241786RN",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pacific City, OR

• Julie Ann Krohn
• Heidi Marian Manning, LAC., LMT
• Northwest Medical Foundation of Tillamook
• Janelle Stacy, PT
• Shelley Collins Stephens, LMT
• Albert P Thompson, M.D.
• Myra L Thompson, F.N.P.
• Elisabeth Vitale, LAC
• Grant R Williams, DMD

All providers in Pacific City, OR · Pediatric Nurse Practitioner in Oregon