Kevin Norman Probst, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

000038096N3 Issued in OR

Practice address

3550 N. Interstate Ave.
Portland, OR 97227-1097

Phone

(503) 331-6493

Fax

(503) 249-5528

NPI assigned

Aug 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770696221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5820 BIRD SONG WAY",
            "city": "GLADSTONE",
            "state": "OR",
            "postal_code": "970271581",
            "telephone_number": "503-341-4039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 N. INTERSTATE AVE.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271097",
            "telephone_number": "503-331-6493",
            "fax_number": "503-249-5528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROBST",
        "first_name": "KEVIN",
        "middle_name": "NORMAN",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WA",
            "license": "AP30005823",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "000038096N3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pro Wellness Chiropractic, LLC
• Pro-Step Rehab
• Jordan Guy Probasco, D.C.
• Aaron Probert
• Amber Probert
• Sarah Probst, M.A., LPCI
• Procare Chiropractic Center LLC
• Procare Pharmacy, L.L.C.
• Andrew R Prochniak, LPC
• Christina Procopio

• Adult Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Adult Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.