Provider Demographics
NPI:1396118469
Name:TRAUGOTT, KERRY LEE (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:LEE
Last Name:TRAUGOTT
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:DR
Other - First Name:KERRY
Other - Middle Name:LEE
Other - Last Name:BOWDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 6048
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6048
Mailing Address - Country:US
Mailing Address - Phone:541-382-4900
Mailing Address - Fax:
Practice Address - Street 1:2405 E 17TH AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223
Practice Address - Country:US
Practice Address - Phone:509-720-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202011163NP-PP363LF0000X
WAAP60605300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500815586Medicaid