Sid Christian Keomanivong

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

201806379NP-PP Issued in OR

Practice address

2677 Beall LN
Central Point, OR 97502-1462

Phone

(702) 343-0466

NPI assigned

Aug 3, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1533254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570492800000",
    "number": "1760960462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3344 WINTERHAVEN ST",
            "address_2": "UNIT 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891085064",
            "telephone_number": "702-343-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2677 BEALL LN",
            "city": "CENTRAL POINT",
            "state": "OR",
            "postal_code": "975021462",
            "telephone_number": "702-343-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEOMANIVONG",
        "first_name": "SID",
        "middle_name": "CHRISTIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-03",
        "last_updated": "2019-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OR",
            "license": "201806379NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• KCB Transport LLC
• Nancy Keith
• Diana J Kelley, L.M.T.
• Kelty Chiropractic, PC
• Robert M Kelty, D.C., P.C.
• Martin Andrew Kirk
• Nancy Alice Knechel, PHD, MSN, NP
• Knight Fire Rescue Consulting
• Summer Dawn Knitter, MSW
• Kristy A Knutson

• Primary Care Nurse Practitioner in Central Point, OR
• Providers in Central Point, OR by specialty
• Primary Care Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.