Active NPI
Marcus Gladney
- Student in an Organized Health Care Education/Training Program
- Beaverton, OR
National Provider Identifier
1891552311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 16614 NW Norwalk Dr
Beaverton, OR 97006-5279 - Phone
- (503) 332-9518
- NPI assigned
- Mar 1, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | WA | ||
| Student in an Organized Health Care Education/Training Program | 390200000X | WA | Primary |
Addresses
Primary practice location
16614 NW Norwalk Dr
Beaverton, OR 97006-5279
Mailing address
16614 NW Norwalk Dr
Beaverton, OR 97006-5279
Phone (503) 332-9518
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709251200000",
"number": "1891552311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16614 NW NORWALK DR",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970065279",
"telephone_number": "503-332-9518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16614 NW NORWALK DR",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970065279",
"telephone_number": "503-332-9518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLADNEY",
"first_name": "MARCUS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-01",
"last_updated": "2024-03-01",
"certification_date": "2024-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WA",
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "WA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.