MR. JACOB CREVISTON


Address: 314 Ne 19th Ave, Portland, OR 97232-2829
Phone: 5032398181

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).

Provider Overview

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

Taxonomy

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

Office Location

Street Address 314 NE 19TH AVE
City PORTLAND
State OR
Zip Code 97232-2829

Providers in the same location

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
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NPI Name Taxonomy Address Enumeration
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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
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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

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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
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Competitor

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City PORTLAND
Zip Code 97232

Improve Information

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Dataset Information

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.

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