KYLA M MCCORMICK (NPI# 1205476777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205476777 |
| Entity Type | Individual |
| Full Name | KYLA M MCCORMICK |
| Credential | CRM |
| Practice Address |
109 Nw Manzanita Avenue Grants Pass OR 97526 |
| Mailing Address |
1215 Sw G St Grants Pass OR 97526-2544 |
| Practice Telephone | 5414798847 |
| Mailing Telephone | 5414762373 |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2020-01-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | 19-CRM-273 | OR | Other Service Providers |
| Street Address |
109 NW MANZANITA AVENUE |
| City | GRANTS PASS |
| State | OR |
| Zip Code | 97526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164076469 | Alicia Yvonne Hansen | Counselor | 1055 Clarey St., Grants Pass, OR 97526 | 2019-07-25 |
| 1841842598 | Michael Liam Reynolds, Dds, LLC | Dentist | 984 Ne 8th Street, Grants Pass Oregon, Grants Pass, OR 97526 | 2019-07-12 |
| 1881254746 | Brandi Mccrorey | Counselor | 418 Ne 6th Street, Suite 102, Grants Pass, OR 97526 | 2019-06-13 |
| 1700364502 | Premier Community Supports, LLC. | Day Training, Developmentally Disabled Services | 1439 Ne 6th St Ste C, Grants Pass, OR 97526 | 2018-08-02 |
| 1821584509 | Stefani Mcintyre | Massage Therapist | 1590 Se N Street, Warehouse #1574, Grants Pass, OR 97526 | 2018-07-06 |
| 1114467438 | Sandra P Martin | Chiropractor | 333 Sw 5th St. Suite B, Grants Pass, OR 97526 | 2017-03-06 |
| 1801347612 | Maci Wageman | Counselor | 1215 Sw G St Grants Pass Oregon 97526, Grants Pass, OR 97526 | 2016-10-17 |
| 1902353907 | Optimal Health of Southern Oregon, LLC | Family Medicine | 1600 Nw 6th St South Suite, Grants Pass, OR 97526 | 2016-09-07 |
| 1982150793 | Tanya White | Counselor | 402 Nw Fstreet, Grants Pass, OR 97526 | 2016-08-31 |
| 1871968602 | Jeffrey A Christophersen | Counselor | 109 Nw Manzanita Ave, Grants Pass, OR 97526 | 2015-12-04 |
| Find all providers in zip 97526 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134752579 | Lisa Kennedy | Peer Specialist | 132 Ne B St # 24, Grants Pass, OR 97526-2114 | 2020-02-13 |
| 1922654201 | Titan Colby Marval | Peer Specialist | 109 N.e. Menzanita Avenue, Grants Pass, OR 97526-1400 | 2019-08-13 |
| 1881063956 | Monica Conley | Peer Specialist | 1215 Sw G Street, Grants Pass, OR 97526-2544 | 2015-09-18 |
| 1346871555 | Benjamin Tayson | Peer Specialist | 356 Ne Beacon Dr, Grants Pass, OR 97526-3815 | 2020-01-28 |
| 1881237022 | Jestin Murphy | Peer Specialist | 1215 Sw G St, Grants Pass, OR 97526-2544 | 2019-10-21 |
| 1053966218 | Dana Alan Zavolta | Peer Specialist | 320 Sw Ramsey Ave, Grants Pass, OR 97527-5529 | 2019-08-05 |
| 1295389427 | Patricia Arleen Kraemer | Peer Specialist | 1545 Harbeck Rd, Grants Pass, OR 97527-5605 | 2019-07-25 |
| 1801351465 | Anna Waldon | Peer Specialist | 418 Nw 6th St, Grants Pass, OR 97526-2006 | 2019-02-07 |
| 1801367958 | Cynthia Batchelor | Peer Specialist | 1920 Sw Kurtz Ln, Grants Pass, OR 97526-2803 | 2018-12-16 |
| 1053893297 | Steven Maurice Richards | Peer Specialist | 1181 Sw Ramsey Ave, Grants Pass, OR 97527-5835 | 2018-09-04 |
| Find all providers in GRANTS PASS | ||||
| City | GRANTS PASS |
| Zip Code | 97526 |
Please comment or provide details below to improve the information on KYLA M MCCORMICK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.