KELLIE L GRAYBOSCH (NPI# 1720362882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720362882 |
| Entity Type | Individual |
| Full Name | KELLIE L GRAYBOSCH |
| Credential | PA-C |
| Practice Address |
9427 Sw Barnes Rd Ste 495 Portland OR 97225-6652 |
| Mailing Address |
Po Box 3158 Portland OR 97208-3158 |
| Practice Telephone | 5032161661 |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2016-09-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA156616 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500640073 | 05 | |
| OR | RR MEDICARE (PH&S) | P01046628 | 01 |
| Street Address |
9427 SW BARNES RD STE 495 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97225-6652 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407851363 | Bernard A Gasch | Dermatology | 9427 Sw Barnes Rd, Suite 495, Portland, OR 97225-6652 | 2005-06-16 |
| 1316473564 | Providence | General Acute Care Hospital | 9427 Sw Barnes Rd, Sutie 295, Portland, OR 97225 | 2017-05-10 |
| 1316318124 | Jun-nicole Matsushita | Doula | 9427 Sw Barnes Rd, Suite 395, Portland, OR 97225-6652 | 2015-10-20 |
| 1457759318 | Providence Health & Services - Oregon | Pediatrics | 9427 Sw Barnes Rd, Ste 395, Portland, OR 97225-6652 | 2014-12-09 |
| 1912324963 | Transitional Care Alliance | Nurse Practitioner | 9427 Sw Barnes Rd, Portland, OR 97225-6652 | 2014-03-27 |
| 1760818447 | Meegan Marie Mangum | Physician Assistant | 9427 Sw Barnes Rd, Suite 498, Portland, OR 97225-6652 | 2013-09-25 |
| 1083059778 | Providence Health & Services - Oregon | Obstetrics & Gynecology | 9427 Sw Barnes Rd, Suite 599, Portland, OR 97225-6652 | 2013-05-08 |
| 1912341108 | Emmanuel Rey Ariola | Registered Nurse | 9427 Sw Barnes Rd, Suite 495, Portland, OR 97225-6652 | 2013-04-18 |
| 1023359213 | Cheri Lynn Belling | Nurse Practitioner | 9427 Sw Barnes Rd, Suite 595, Portland, OR 97225-6652 | 2013-03-13 |
| 1639436074 | Alison Christy | Psychiatry & Neurology | 9427 Sw Barnes Rd, Suite 395, Portland, OR 97225-6652 | 2012-04-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508425034 | Gabrielle Gonzales | Behavior Technician | 1675 Sw Marlow Ave, Suite 200, Portland, OR 97225 | 2019-06-08 |
| 1558844555 | Tate Roseberry | Behavior Technician | 1675 Sw Marlow Avenue, Suite 200, Portland, OR 97225 | 2018-09-14 |
| 1982186300 | Dean Alan Hopkins | Registered Nurse | 11782 Sw Barnes Rd, Suite 300, Portland, OR 97225 | 2018-09-01 |
| 1316449168 | Surgery Center At St. Vincent, LLC | Clinic/Center | 9135 Sw Barnes Rd Ste 161, Portland, OR 97225 | 2018-03-07 |
| 1730606716 | Meghan Louise Lacy | Pediatrics | 11790 Sw Barnes Rd, Blg. A, Suite 140, Portland, OR 97225 | 2017-08-29 |
| 1841733433 | Tia Pugh | Occupational Therapist | 9155 S.w. Barnes Road, East Pavilion, Portland, OR 97225 | 2016-11-30 |
| 1295185585 | Stephanie Lynn Hart | Nurse Practitioner | 9155 Sw Barnes Rd Ste 240, Portland, OR 97225 | 2016-06-16 |
| 1962866244 | Bejian Shamloo | Chiropractor | 10200 Sw Eastridge St., Suite 235, Portland, OR 97225 | 2016-04-12 |
| 1992162630 | Robert Joseph Yoder | Psychologist | 9045 Barnes Rd, Portland, OR 97225 | 2016-01-26 |
| 1316303951 | Katie Herold | Chiropractor | 9315 Sw Morrison St, Portland, OR 97225 | 2016-01-12 |
| Find all providers in zip 97225 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427676493 | Lindsey Louise Peterson | Physician Assistant | 3505 N Williams Ave, Portland, OR 97227-1437 | 2020-07-07 |
| 1518584036 | Abigail Nichole Dumont | Physician Assistant | 6064 Sw 30th Ave, Portland, OR 97239-1018 | 2020-06-30 |
| 1336769637 | Molly Tanguay | Physician Assistant | 23 Bramhall St, Portland, ME 04102-3121 | 2020-04-16 |
| 1063040525 | Jessica Nursick | Physician Assistant | 26 Sand Hill Rd, Portland, CT 06480-1737 | 2020-03-31 |
| 1689217630 | Evan Eisher | Physician Assistant | 3809 Se Stephens St, Portland, OR 97214-5248 | 2019-10-22 |
| 1508407941 | Amie Bates | Physician Assistant | 1040 Nw 22nd Ave # Ll030, Portland, OR 97210-3057 | 2019-10-07 |
| 1558923326 | Mackenzie Graye Mcmillin | Physician Assistant | 1601 Congress St Ste 1, Portland, ME 04102-2145 | 2019-07-02 |
| 1447812268 | Maksim Yefimov | Physician Assistant | 2800 N Vancouver Ave Ste 130, Portland, OR 97227 | 2019-07-01 |
| 1942794839 | Michael Peterson | Physician Assistant | 3181 Sw Sam Jackson Park Rd # P31, Portland, OR 97239-3098 | 2018-06-14 |
| 1306383930 | Rachel Lynn Witowski | Physician Assistant | 2124 Nw Hoyt St, Portland, OR 97210-3215 | 2017-01-20 |
| 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.