| Ko-kwell Wellness Center | |
|
630 Miluk Dr Coos Bay OR 97420-7728 | |
| (541) 888-9494 | |
| (541) 888-4435 |
| Full Name | Ko-kwell Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 630 Miluk Dr, Coos Bay, Oregon |
| Authorized Official Name and Position | Amber Robertson (BILLING MANAGER) |
| Authorized Official Contact | 5418889494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ko-kwell Wellness Center Po Box 3190 Coos Bay OR 97420-0407 Ph: (541) 888-9494 | Ko-kwell Wellness Center 630 Miluk Dr Coos Bay OR 97420-7728 Ph: (541) 888-9494 |
| NPI Number | 1376592287 |
|---|---|
| Provider Enumeration Date | 05/08/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 6002805330 |
|---|---|
| Medicare Enrollment ID | O20040511000663 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376592287 | NPI | - | NPPES |
| 165031 | Medicaid | OR | |
| 261Q00000X | Other | OR | TAXONOMY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Oregon) | Primary |
| Provider Name | Rajesh Ravuri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952386112 PECOS PAC ID: 9830188515 Enrollment ID: I20040507001260 |
| Provider Name | Roger C Willis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477501815 PECOS PAC ID: 1759311483 Enrollment ID: I20060712000344 |
| Provider Name | Leann J Willis Welch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679523971 PECOS PAC ID: 8527067545 Enrollment ID: I20061220000132 |
| Provider Name | John M Meyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598801292 PECOS PAC ID: 2466678800 Enrollment ID: I20140721002549 |
| Provider Name | Keerti Jaini |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386908598 PECOS PAC ID: 6002120326 Enrollment ID: I20150730013448 |
| Provider Name | Felisha A Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588061048 PECOS PAC ID: 1658680780 Enrollment ID: I20151228001975 |
| Provider Name | Kim A Codding |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326358607 PECOS PAC ID: 8426200494 Enrollment ID: I20170307000864 |
| Provider Name | Tia M Cloke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760821698 PECOS PAC ID: 3173757440 Enrollment ID: I20180205001044 |
| Provider Name | Kimberly A Cotton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194757385 PECOS PAC ID: 5193768588 Enrollment ID: I20180501000811 |
| Provider Name | Sandy Lynn Teeter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477189009 PECOS PAC ID: 1557771557 Enrollment ID: I20201103000873 |
| Provider Name | Kimberly Ann Kyllo-martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649849142 PECOS PAC ID: 5991106841 Enrollment ID: I20210629002256 |
| Provider Name | Jennifer Dawn Hope |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518133487 PECOS PAC ID: 0244389823 Enrollment ID: I20211007000825 |
| Provider Name | Lindsay Marie Reeves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336895556 PECOS PAC ID: 7214324425 Enrollment ID: I20220418001467 |
| Provider Name | Antonia Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619377322 PECOS PAC ID: 9931426558 Enrollment ID: I20230215000855 |
| Provider Name | Rayshal Spalding |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1891261996 PECOS PAC ID: 4385998871 Enrollment ID: I20230612002305 |
| Provider Name | Leeandria Witcraft |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053884791 PECOS PAC ID: 5193130110 Enrollment ID: I20240129001025 |
| Provider Name | Kenda Margaret Plate |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376066746 PECOS PAC ID: 4284070764 Enrollment ID: I20240306003292 |
| Provider Name | Gina Marie Allison |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669787115 PECOS PAC ID: 3072950278 Enrollment ID: I20240324000079 |
Coos Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 320 Central Ave, Suite 418, Coos Bay, OR 97420 Phone: 541-294-0257 | |
Coquille Valley Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2699 N 17th St, Coos Bay, OR 97420 Phone: 541-266-3600 Fax: 541-824-1702 | |
Nbmc-main Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1900 Woodland Dr, Coos Bay, OR 97420 Phone: 541-267-5151 Fax: 541-266-4501 | |
Proactive Nutrition & Wellness Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1455 Laurel Ave, Coos Bay, OR 97420 Phone: 727-409-0016 | |
Waterfall Clinic, Incorporated Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 826 S 11th St, Coos Bay, OR 97420 Phone: 541-756-6232 Fax: 541-756-6234 | |
Dr. King Scope Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2699 N 17th St, Coos Bay, OR 97420 Phone: 541-269-7358 |