Erin Kathleen O'Neel Kershisnik, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD000035135 Issued in WA

Practice address

1603 Cooper Point Rd NW
Olympia, WA 98502-8325

Phone

(360) 438-1161

Fax

(360) 438-6690

NPI assigned

Sep 28, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2014 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1861584161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1603 COOPER POINT RD NW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028325",
            "telephone_number": "360-438-1161",
            "fax_number": "360-438-6690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 COOPER POINT RD NW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028325",
            "telephone_number": "360-438-1161",
            "fax_number": "360-438-6690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSHISNIK",
        "first_name": "ERIN",
        "middle_name": "KATHLEEN O'NEEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD000035135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8224685",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Tracy Kenworthy
• Stephen Bonney Kern, D.M.D.
• Kerry J Dyer Lac PLLC
• Fran Kersch, PT
• Jennifer Lee Kersey
• Tara Kessel, LICSW
• Leo Wolfgang Kesting, M.D.
• Mary Ketchum, RDN, CD
• Keybridge Health Supplies LLC
• Keybridge Health Supplies PLLC

• Family Medicine Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.