NATHAN GREY LYSTRUP (NPI# 1659825651) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659825651 |
| Entity Type | Individual |
| Full Name | NATHAN GREY LYSTRUP |
| Credential | F.N.P. |
| Practice Address |
450 Tatone St Boardman OR 97818-8076 |
| Mailing Address |
1967 Ne 2nd St Hermiston OR 97838-1721 |
| Practice Telephone | 5414817212 |
| Practice Fax Number | 5414812020 |
| Mailing Telephone | 7025964157 |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2016-08-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 201605982RN | OR | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
201605983NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
450 TATONE ST |
| City | BOARDMAN |
| State | OR |
| Zip Code | 97818-8076 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396740585 | Stevens Cloyd Marshall | Family Medicine | 450 Tatone St, Boardman, OR 97818-8076 | 2005-06-15 |
| 1235753815 | Nyle Gunter | Physician Assistant | 450 Tatone St, Boardman, OR 97818-8076 | 2020-05-30 |
| 1720622566 | Sonja L Neal | Registered Nurse | 450 Tatone St, Boardman, OR 97818-8076 | 2019-11-05 |
| 1134635790 | Austin Ivins Higginson | Physician Assistant | 450 Tatone St, Boardman, OR 97818-8076 | 2017-12-19 |
| 1891207486 | Alysia Marie Mcdonald | Physician Assistant | 450 Tatone St, Boardman, OR 97818-8076 | 2017-11-03 |
| 1295099422 | Terri Louise Dickens Landreth | Psychologist | 450 Tatone St, Boardman, OR 97818-8076 | 2012-07-03 |
| 1194901785 | Geoffrey Lee Thomas | Emergency Medicine | 450 Tatone St, Boardman, OR 97818-8076 | 2008-01-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477178721 | Kaelyn Rose Lindsay | Counselor | 104 Sw Kinkade Ave., Boardman, OR 97818 | 2020-06-12 |
| 1225674807 | Jose James Ortiz Jr. | Counselor | 104 Kinkade Ave, Boardman, OR 97818 | 2019-11-19 |
| 1982149647 | Kymberli Dawn Erevia | Specialist | 104 S. W. Kinkade Road, Boardman, OR 97818 | 2017-01-04 |
| 1194277814 | Scott R Ruch | Community/Behavioral Health | 104 Sw. Kinkade Rd, Boardman, OR 97818 | 2016-10-28 |
| 1144660168 | Cydney M. Morgan | Counselor | 103 Sw Kinkade Rd., Boardman, OR 97818 | 2013-07-05 |
| 1801151121 | Mayra Colin Carrillo | Counselor | 104 S.w. Kinkade Rd., Boardman, OR 97818 | 2012-07-12 |
| 1306103429 | Good Shepherd Medical Service Corp | Pharmacy | 220 S. Main, Boardman, OR 97818 | 2012-04-13 |
| 1437359387 | Emily Dawn Reynolds | Counselor | 104 Sw Kinkade Road, Boardman, OR 97818 | 2007-07-19 |
| 1548485865 | Hayden Family Dentistry Group | Dentist | 300 Tatone, Boardman, OR 97818 | 2007-04-13 |
| 1336294057 | Brandi Nichole Pollick | Counselor | 101 Nw Boardman Ave, Boardman, OR 97818 | 2007-01-24 |
| Find all providers in zip 97818 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881153377 | Sabrina Kifer | Nurse Practitioner | 7629 Market St Ste 100, Boardman, OH 44512-6051 | 2019-03-14 |
| 1518446178 | Joey Michelle Annichine | Nurse Practitioner | 1306 Mere Ct, Boardman, OH 44512-3715 | 2018-08-14 |
| 1639565062 | Brenda Schell | Nurse Practitioner | 783 Presidential Dr, Boardman, OH 44512-5714 | 2015-04-13 |
| 1144861857 | Molly Corlew | Nurse Practitioner | 250 Debartolo Pl, Boardman, OH 44512-7004 | 2019-10-03 |
| 1083270987 | Ryan L Scragg | Nurse Practitioner | 7206 Market St Ste A, Boardman, OH 44512-4562 | 2019-05-15 |
| 1255994356 | Cortney Ann Birchak | Nurse Practitioner | 7430 Southern Blvd, Boardman, OH 44512-5629 | 2019-04-15 |
| 1750870333 | Kimberly Ann Szabo | Nurse Practitioner | 8440 Market St, Boardman, OH 44512-6703 | 2018-05-09 |
| 1588168579 | Jill Christine Gulling | Nurse Practitioner | 6505 Market St Bldg A1, Boardman, OH 44512-3457 | 2018-03-22 |
| 1215445507 | Suzanne Cavalier | Nurse Practitioner | 7230 Market St, Boardman, OH 44512-4513 | 2018-01-20 |
| 1972022804 | Francesca Marie Crum | Nurse Practitioner | 8401 Market St, Boardman, OH 44512 | 2017-09-12 |
| Find all providers in BOARDMAN | ||||
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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.