Troy Lewellyn
Individual provider Active NPI Community Health Worker · Enterprise, OR
NPI 1982486809 · NPPES record last updated Oct 16, 2023
Key facts
- NPI
- 1982486809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- License
- 109628 (OR)
- Practice address
- 603 Medical Pkwy
Enterprise, OR 97828-5124 - Phone
- (541) 426-4502
- Fax
- (541) 426-6403
- NPI assigned
- Oct 16, 2023
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109628 | OR | MD | Community Health Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 109628 | OR | Yes |
Addresses
Primary practice location
603 Medical Pkwy
Enterprise, OR 97828-5124
Mailing address
603 Medical Pkwy
Enterprise, OR 97828-5124
Phone (541) 426-4502
Other providers in Enterprise, OR
- Jackson Duane Law
- Lawrence Leonard Woods
- Ronald Duy Le
- Katrina Leith
- Anna Lembke
- Vanessa Lewis
- Kayla Linville
- Jennifer Little
- Shane Lodder
- Lauren Macdonald
All providers in Enterprise, OR · Community Health Worker in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.