Healthcare Provider Details

I. General information

NPI: 1396114955
Provider Name (Legal Business Name): ERIK JON DOMINGER PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SE 6TH ST STE 310
GRANTS PASS OR
97526-2471
US

IV. Provider business mailing address

1630 WILLIAMS HWY # 279
GRANTS PASS OR
97527-5660
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-2373
  • Fax: 541-476-1526
Mailing address:
  • Phone: 541-476-2373
  • Fax: 541-476-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201502991RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202204953NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: