Healthcare Provider Details

I. General information

NPI: 1477409266
Provider Name (Legal Business Name): JOHN T EARLY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 SE STARK ST STE 205
GRESHAM OR
97030-3382
US

IV. Provider business mailing address

18296 S SCOTTS LN
OREGON CITY OR
97045-8129
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-1010
  • Fax:
Mailing address:
  • Phone: 541-429-1269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number10057503
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: