Provider Demographics
NPI:1386144962
Name:ARCHIBALD GOERS, KALEY BRIANNE (FNP)
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:BRIANNE
Last Name:ARCHIBALD GOERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:RHODODENDRON
Mailing Address - State:OR
Mailing Address - Zip Code:97049-0133
Mailing Address - Country:US
Mailing Address - Phone:907-687-5567
Mailing Address - Fax:
Practice Address - Street 1:37400 BELL ST
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-7868
Practice Address - Country:US
Practice Address - Phone:503-668-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201809720NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily