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NPI Code Detail

MEDICARE: RKI PRIMARY CARE AT HOME

MEDICARE: RKI PRIMARY CARE AT HOME
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1043157985
Entity Type Code : Organization
Provider Name (Legal Business Name) : RKI PRIMARY CARE AT HOME
Provider Business Mailing Address
First Line : 2685 25TH AVE
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-3098
Country : US
Telephone Number : 781-971-2525
Fax Number :
Provider Business Practice Location Address
First Line : 2685 25TH AVE
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-3098
Country : US
Telephone Number : 781-971-2525
Fax Number :
Authorized Official
Title or Position : CEO/OWNER
Name : UCHECHUKWU EZEDI
Credential : FNP
Telephone Number : 781-971-2525
Provider Enumeration Date : 04/29/2026
Last Update Date : 04/29/2026

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