Healthcare Provider Details

I. General information

NPI: 1134583149
Provider Name (Legal Business Name): KANNACT HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NE JACK LONDON ST STE 200
CORVALLIS OR
97330-6947
US

IV. Provider business mailing address

2211 NW PROFESSIONAL DR
CORVALLIS OR
97330-3891
US

V. Phone/Fax

Practice location:
  • Phone: 855-722-5513
  • Fax: 541-230-1189
Mailing address:
  • Phone: 855-722-5513
  • Fax: 541-230-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KRISHNA RAO
Title or Position: CEO
Credential:
Phone: 971-361-6091