Individual provider Active NPI

Kerry Lyn Harrington, PA-C

  • Physician Assistant
  • Roseburg, OR
National Provider Identifier
1760473060
Registry record updated Jan 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01176 Issued in OR
Practice address
1740 NW Goetz St
Roseburg, OR 97471-1613
Phone
(541) 640-7625
NPI assigned
Nov 4, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA01176 OR Primary
Emergency Medicine Physician 207P00000X PA16258 CA

Addresses

Primary practice location

1740 NW Goetz St
Roseburg, OR 97471-1613

Mailing address

1292 High St Ste 224
Eugene, OR 97401-3238
Phone (541) 500-2500

Other identifiers 1

IdentifierTypeStateIssuer
OPA162580MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jul 1, 2021 through Jul 1, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA01176ORMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1760473060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 HIGH ST STE 224",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013238",
            "telephone_number": "541-500-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 NW GOETZ ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974711613",
            "telephone_number": "541-640-7625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRINGTON",
        "first_name": "KERRY",
        "middle_name": "LYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-04",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01176",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "PA16258",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OPA162580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.