Active NPI
Amelia Kathleen Cancilla, DTTAC LIFESTYLE COAC
- Health Educator
- John Day, OR
National Provider Identifier
1669960530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Educator
- Practice address
- 528 E Main St Ste E
John Day, OR 97845-1289 - Phone
- (541) 575-0429
- NPI assigned
- Apr 26, 2018
- 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 |
|---|---|---|---|---|
| Health Educator | 174H00000X | Primary |
Addresses
Primary practice location
528 E Main St Ste E
John Day, OR 97845-1289
Mailing address
528 E Main St Ste E
John Day, OR 97845-1289
Phone (541) 575-0429
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524700800000",
"number": "1669960530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "528 E MAIN ST STE E",
"city": "JOHN DAY",
"state": "OR",
"postal_code": "978451289",
"telephone_number": "541-575-0429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "528 E MAIN ST STE E",
"city": "JOHN DAY",
"state": "OR",
"postal_code": "978451289",
"telephone_number": "541-575-0429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANCILLA",
"first_name": "AMELIA",
"middle_name": "KATHLEEN",
"credential": "DTTAC LIFESTYLE COAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-26",
"last_updated": "2018-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in John Day, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.