Active NPI
Kelly McMullen, LMT
- Prevention Professional
- Portland, OR
National Provider Identifier
1558892471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 20211
- Practice address
- 819 SE Morrison St
Suite 140
Portland, OR 97214-6307 - Phone
- (702) 480-6028
- NPI assigned
- Mar 22, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 20211 | OR | Primary |
Addresses
Primary practice location
819 SE Morrison St
Suite 140
Portland, OR 97214-6307
Mailing address
819 SE Morrison St
Suite 140
Portland, OR 97214-6307
Phone (702) 480-6028
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20211 | OR | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490140800000",
"number": "1558892471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "819 SE MORRISON ST",
"address_2": "SUITE 140",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972146307",
"telephone_number": "702-480-6028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "819 SE MORRISON ST",
"address_2": "SUITE 140",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972146307",
"telephone_number": "702-480-6028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCMULLEN",
"first_name": "KELLY",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-22",
"last_updated": "2017-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "OR",
"license": "20211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.