=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366364333
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN O'ROURKE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2026
-----------------------------------------------------
Last Update Date | 07/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 W SPERRY ST PO BOX 469
-----------------------------------------------------
City | HEPPNER
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-676-9161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1213 NW HORN AVE
-----------------------------------------------------
City | PENDLETON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97801-1253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-676-9161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | 117594
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------