NPIMap

Individual provider Active NPI

Kaitlyn Mary McGowan, AGPCNP-BC

  • Gerontology Nurse Practitioner
  • Newberg, OR
National Provider Identifier
1619513769
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
202008069NP-PP Issued in OR
Practice address
1000 N Providence Dr Ste 120
Newberg, OR 97132-7582
Phone
(503) 537-5900
NPI assigned
Nov 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95013322 CA
Nurse Practitioner 363L00000X 202008069NP-PP OR
Gerontology Nurse Practitioner 363LG0600X 202008069NP-PP OR Primary

Addresses

Primary practice location

1000 N Providence Dr Ste 120
Newberg, OR 97132-7582

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Other practice location 1

3445 Boone Rd SE
Salem, OR 97317-9336
Phone (412) 720-9570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201204001284 OR Practitioner - Nurse Practitioner 0143658328 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians

Practice addresses (Care Compare)

1000 N Providence Dr
Suite 120
Newberg, OR 97132-7582
Phone (503) 537-5900

Hospital & facility affiliations

  • Providence Home Health Home health agency, Portland, OR, CCN 387048
  • Providence Newberg Medical Center Hospital, Newberg, OR, CCN 380037
  • Salem Hospital Hospital, Salem, OR, CCN 380051
  • Willamette Valley Medical Center Hospital, McMinnville, OR, CCN 380071
  • Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
202008069NP-PPORMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Jul 31, 2023 Accepting new patients
Providence Health & Services Oregon CurrentSince Jul 31, 2023 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
El Camino Health Medical Group PastSince Jan 29, 2020 Accepting new patients

Locations

1000 N Providence Dr
Ste 120
Newberg, OR 97132
Phone (503) 537-5700

1003 N Providence Dr
Ste 325
Newberg, OR 97132
Phone (503) 216-1661

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1619513769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N PROVIDENCE DR STE 120",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971327582",
            "telephone_number": "503-537-5900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3445 Boone Rd SE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973179336",
            "country_code": "US",
            "telephone_number": "412-720-9570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCGOWAN",
        "first_name": "KAITLYN",
        "middle_name": "MARY",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-25",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95013322",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "202008069NP-PP",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OR",
            "license": "202008069NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newberg, OR

Sources for this page

Verify at the official NPI Registry.