Basic Information
| Provider Information | |||||||||
| NPI: | 1154707669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALCOTT | ||||||||
| FirstName: | KACIE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3158 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972083158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032160700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 61250 SE COOMBS PL | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977023704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417065930 | ||||||||
| FaxNumber: | 5417065931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2015 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201505550NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.