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General NPI Number Information
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NPI Number | 1396118469
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Entity Type | Individual
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Provider Name | KERRY LEE TRAUGOTT DNP, APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 2405 E 17TH AVE SUITE 113
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City | SPOKANE
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State | WA
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Zip | 99223
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Country | US
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Telephone | 509-720-8516
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6048
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City | BEND
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State | OR
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Zip | 97708-6048
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Country | US
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Telephone | 541-382-4900
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 202011163NP-PP
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License Number State | OR
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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 | AP60605300
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License Number State | WA
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