Kim R Cantwell-Gab, ARNP
Individual provider Active NPI Nurse Practitioner · Medford, OR
NPI 1962601310 · NPPES record last updated Sep 24, 2020
Key facts
- NPI
- 1962601310
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 201503207NP-PP (OR)
- Practice address
- 1698 E McAndrews Rd
Suite 300
Medford, OR 97504-5589 - Phone
- (541) 732-7850
- NPI assigned
- Jul 16, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP30007760 | WA | MD | Nurse Practitioner |
Interoperability endpoints
- kcantwellgab735513@oc.providencedirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AP30007760 | WA | |
| Nurse Practitioner | 363L00000X | 201503207NP-PP | OR | Yes |
Addresses
Primary practice location
1698 E McAndrews Rd
Suite 300
Medford, OR 97504-5589
Mailing address
520 Medical Center Dr
Ste 200
Medford, OR 97504-4314
Phone (541) 732-7850
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9653080 | Medicaid | WA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kcantwellgab735513@oc.providencedirect.org |
Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.