Active NPI
Tracy Lynn Prevost, LMT
- Chiropractor
- Beaverton, OR
National Provider Identifier
1578816286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3244
- Practice address
- 15050 SW Koll Pkwy
Beaverton, OR 97006-6001 - Phone
- (503) 439-9494
- NPI assigned
- Oct 18, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3244 | OR | Primary |
Addresses
Primary practice location
15050 SW Koll Pkwy
Beaverton, OR 97006-6001
Mailing address
15050 SW Koll Pkwy
Beaverton, OR 97006
Phone (503) 439-9494
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 |
|---|---|---|---|
| 3244 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350518400000",
"number": "1578816286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15050 SW KOLL PKWY",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "97006",
"telephone_number": "503-439-9494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15050 SW KOLL PKWY",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970066001",
"telephone_number": "503-439-9494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREVOST",
"first_name": "TRACY",
"middle_name": "LYNN",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-18",
"last_updated": "2012-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OR",
"license": "3244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.