Active NPI
Kathleen M Waybrant, FNP
- Family Nurse Practitioner
- Roseburg, OR
National Provider Identifier
1942273008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 080045889N1
- Practice address
- 1813 W Harvard Ave
Ste 201
Roseburg, OR 97471-2754 - Phone
- (541) 440-6390
- Fax
- (541) 440-6392
- NPI assigned
- Feb 9, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 80045889N1 | OR | |
| Family Nurse Practitioner | 363LF0000X | 080045889N1 | OR | Primary |
Addresses
Primary practice location
1813 W Harvard Ave
Ste 201
Roseburg, OR 97471-2754
Mailing address
1813 W Harvard Ave
Ste 201
Roseburg, OR 97471-2754
Phone (541) 440-6390
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 168395 | Medicaid | OR | |
| R103163 | Other | MCR PART B | |
| 154971 | Medicaid | OR |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80045889N1 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543449600000",
"number": "1942273008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1813 W HARVARD AVE",
"address_2": "STE 201",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974712754",
"telephone_number": "541-440-6390",
"fax_number": "541-440-6392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1813 W HARVARD AVE",
"address_2": "STE 201",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974712754",
"telephone_number": "541-440-6390",
"fax_number": "541-440-6392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAYBRANT",
"first_name": "KATHLEEN",
"middle_name": "M",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-09",
"last_updated": "2018-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "80045889N1",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OR",
"license": "080045889N1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "168395",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCR PART B",
"identifier": "R103163",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "154971",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.