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General NPI Number Information
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NPI Number | 1740821453
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Entity Type | Individual
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Provider Name | KELLIE MARIE CREASER DNP, PMHNP-BC, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 648 CHETCO AVE
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City | BROOKINGS
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State | OR
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Zip | 97415-8010
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Country | US
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Telephone | 541-351-9149
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Fax | 503-914-6686
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Provider Business Mailing Address
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Address Line | 840 HASSETT ST
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City | BROOKINGS
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State | OR
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Zip | 97415-7201
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Country | US
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Telephone | 541-351-9149
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Fax | 503-914-6686
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 201908534NP-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 | 201908534NP-PP
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 201908534NP-PP
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License Number State | OR
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