Healthcare Provider Details

I. General information

NPI: 1710425871
Provider Name (Legal Business Name): ALISON KAST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 03/15/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 BELTLINE RD
SPRINGFIELD OR
97477-1091
US

IV. Provider business mailing address

PO BOX 2847
CORVALLIS OR
97339-2847
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-6005
  • Fax: 541-222-6029
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201809467RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA146213
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201810425NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: