Healthcare Provider Details

I. General information

NPI: 1952859621
Provider Name (Legal Business Name): KENDRA RAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KENDRA RAGAN AGACNP

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 S 58TH ST STE B
SPRINGFIELD OR
97478-7623
US

IV. Provider business mailing address

470 BROOKSIDE DR
EUGENE OR
97405-4926
US

V. Phone/Fax

Practice location:
  • Phone: 541-747-4858
  • Fax:
Mailing address:
  • Phone: 623-980-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number201606703NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: