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General NPI Number Information
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NPI Number | 1154916773
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Entity Type | Individual
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Provider Name | CHRIS MCKEOWN FNP-C
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Gender | Male
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 675 ORCHARD HEIGHTS RD NW STE 120
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City | SALEM
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State | OR
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Zip | 97304-3042
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Country | US
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Telephone | 815-499-4742
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Fax |
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Provider Business Mailing Address
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Address Line | 675 ORCHARD HEIGHTS RD NW STE 120
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City | SALEM
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State | OR
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Zip | 97304-3042
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Country | US
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Telephone | 815-499-4742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209022602
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 202107301NP-PP
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License Number State | OR
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