Healthcare Provider Details

I. General information

NPI: 1881730554
Provider Name (Legal Business Name): ERIN KELLY COOLEY M.D., F.A.C.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN K. CAMPAIGNIAC M.D.

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 NW SAMARITAN DR STE 201
CORVALLIS OR
97330-3785
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number229226
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number29237
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberMD175774
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: