MR. JACOB CREVISTON (NPI# 1528460813) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528460813 |
| Entity Type | Individual |
| Full Name | MR. JACOB CREVISTON |
| Credential | MN, RN, PMHNP-BC |
| Practice Address |
314 Ne 19th Ave Portland OR 97232-2829 |
| Mailing Address |
568 N Buffalo St Portland OR 97217-1560 |
| Practice Telephone | 5032398181 |
| Mailing Telephone | 5035455986 |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-10-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
201405518NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
314 NE 19TH AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97232-2829 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225246440 | Elizabeth Jo Nelson | Counselor | 314 Ne 19th Ave, Portland, OR 97232-2829 | 2007-05-20 |
| 1497216592 | Vera Alcorn | Naturopath | 314 Ne 19th Ave, Portland, OR 97232-2829 | 2019-03-29 |
| 1740764927 | Matthew Raymond Hicks | Naturopath | 314 Ne 19th Ave, Portland, OR 97232-2829 | 2018-09-24 |
| 1285185850 | Lindsay Rodgers | Naturopath | 314 Ne 19th Ave, Portland, OR 97232-2829 | 2016-10-19 |
| 1083169148 | Kelly Austin Mcclung | Massage Therapist | 314 Ne 19th Ave, Portland, OR 97232-2829 | 2016-08-18 |
| 1831542224 | Anne W Taylor | Counselor | 314 Ne 19th Ave, Portland, OR 97232-2829 | 2016-07-20 |
| 1306216155 | After Counseling, LLC | Community/Behavioral Health | 314 Ne 19th Ave, Portland, OR 97232-2829 | 2015-10-05 |
| 1265870315 | Heather M Schrock | Nutritionist | 314 Ne 19th Ave, Portland, OR 97232-2829 | 2013-06-11 |
| 1376893826 | Healthy Living Family Medicine, LLC | Family Medicine | 314 Ne 19th Ave, Portland, OR 97232-2829 | 2012-09-12 |
| 1265795991 | Amenda, LLC | Nutritionist | 314 Ne 19th Ave, Portland, OR 97232-2829 | 2012-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881293215 | Oregon Change Clinic | Clinic/Center | 650 Ne Holladay Street, Suite 1600, Portland, OR 97232 | 2020-10-17 |
| 1154969947 | Lori Kristen Miracle | Acupuncturist | Kwan Yin Healing Arts Center East Inc, 3115 Ne Sandy Blvd. Suite 231, Portland, OR 97232 | 2019-12-12 |
| 1194285411 | Onampai Modina Soondarotok | Student in an Organized Health Care Education/Training Program | Ipp, Oregon Health & Science University, 2214 Lloyd Center, Portland, OR 97232 | 2019-03-22 |
| 1003399635 | Cathleen Nicole Wenberg | Social Worker | 1839 Ne Couch St, Portland, OR 97232 | 2018-09-10 |
| 1508350760 | Float North | Acupuncturist | 1617 Ne 17th Ave., Portland, OR 97232 | 2018-06-20 |
| 1629560719 | Rachael Lee Walters | Doula | 3005 Ne Hoyt St, Portland, OR 97232 | 2018-06-04 |
| 1225529431 | Jason Sutherland | Social Worker | 707 Ne Couch, Portland, OR 97232 | 2018-05-23 |
| 1770089245 | Richard Farwell Leman | Family Medicine | 800 Ne Oregon St., Suite 772, Portland, OR 97232 | 2018-04-03 |
| 1952803413 | Aleksandra Giedowyn Md PC | Family Medicine | 1923 Ne Broadway Street Suite 2, Portland, OR 97232 | 2018-03-01 |
| 1639680374 | Amanda Matteo | Counselor | 20 Ne 10th Ave, Portland, OR 97232 | 2017-10-20 |
| Find all providers in zip 97232 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154920148 | Hardcore Happy LLC | Nurse Practitioner | 740 Ne 116th Ct, Portland, OR 97220-2223 | 2020-10-20 |
| 1457967325 | Megan L Langworthy | Nurse Practitioner | 1914 Se 46th Ave, Portland, OR 97215-3148 | 2020-09-16 |
| 1104446681 | Skycloud Psychiatry LLC | Nurse Practitioner | 106 South West Woods St, Portland, OR 97201 | 2020-04-24 |
| 1730712290 | Lucy Anne Bloedon | Nurse Practitioner | 4020 Sw Iowa St, Portland, OR 97221-3423 | 2020-02-12 |
| 1346802733 | Compass Psychiatric Wellness LLC | Nurse Practitioner | 4300 Ne Fremont St Ste 260, Portland, OR 97213-1100 | 2019-07-05 |
| 1548721871 | Cooke Therapy Pllc | Nurse Practitioner | 1125 Se Madison St Ste 102, Portland, OR 97214-3600 | 2019-03-28 |
| 1245719541 | Scott J Whited | Nurse Practitioner | 216 Vaughan St., Mcgeachy Hall, Portland, ME 04101 | 2018-08-08 |
| 1467969220 | Nw Mind-body Wellness, LLC | Nurse Practitioner | 16986 Nw Lynch Ln, Portland, OR 97229-1221 | 2018-01-02 |
| 1811441348 | Anthony Hoy | Nurse Practitioner | 5562 Se Pine St, Portland, OR 97215-1276 | 2016-08-12 |
| 1700241254 | Jacqueline J Cole | Nurse Practitioner | 5228 Ne Hoyt St Ste 300, Portland, OR 97213-3055 | 2015-12-29 |
| Find all providers in PORTLAND | ||||
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| 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.