Healthcare Provider Details

I. General information

NPI: 1427546498
Provider Name (Legal Business Name): KIMISTRY WELLNESS & PREVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 GOODPASTURE ISLAND RD
EUGENE OR
97401-2109
US

IV. Provider business mailing address

4825 UNTHANK AVE APT 395
EUGENE OR
97402-7683
US

V. Phone/Fax

Practice location:
  • Phone: 571-350-3276
  • Fax:
Mailing address:
  • Phone: 541-636-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KIMBERLY KAY MCGREW
Title or Position: CEO
Credential: CHHP,HC
Phone: 541-636-8415