MEDICARE: KERRY LEE O'BRIEN NP

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
1	363LA2200X	Adult Health Nurse Practitioner	200250084NP	OR
2	363LG0600X	Gerontology Nurse Practitioner	200250083NP	OR
3	363LF0000X	Family Nurse Practitioner	200950006NP	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366418535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY LEE O'BRIEN NP

Provider Business Mailing Address
First Line	:	4560 SE INTERNATIONAL WAY
Second Line	:	SUITE 100
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-4628
Country	:	US
Telephone Number	:	503-312-4607
Fax Number	:	503-296-2408

Provider Business Practice Location Address
First Line	:	4560 SE INTERNATIONAL WAY
Second Line	:	SUITE 100
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-4628
Country	:	US
Telephone Number	:	503-312-4607
Fax Number	:	503-296-2408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	08/10/2020

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Directions to “ KERRY LEE O'BRIEN NP” Practice Location

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