Aceso Medical Clinic LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

ACESO MEDICAL CLINIC LLC

Practice address

375 Park Ave
Coos Bay, OR 97420-2244

Phone

(773) 996-0242

NPI assigned

Jan 5, 2023

Last updated

Jan 5, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shirley Reynolds, FNPNPI 1073097242

Title

Family Nurse Practitioner

Phone

(773) 996-0242

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shirley Deveere Reynolds

  • Nurse Practitioner
  • Coos Bay, OR
  • NPI 1073097242
  NPD Authorized official

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

{
    "created_epoch": "1672876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672876800000",
    "number": "1790499663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "998 INLET LOOP",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974204446",
            "telephone_number": "773-996-0242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 PARK AVE",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202244",
            "telephone_number": "773-996-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACESO MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-05",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "773-996-0242",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; 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.