Provider Demographics
NPI:1790725950
Name:KEARNS, ADAM GEMMILL (CRNA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:GEMMILL
Last Name:KEARNS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 SE SHERRETT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-8675
Mailing Address - Country:US
Mailing Address - Phone:215-262-4718
Mailing Address - Fax:
Practice Address - Street 1:7409 SE SHERRETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-8675
Practice Address - Country:US
Practice Address - Phone:215-262-4718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
WAAP30007764367500000X
WARN00173377163W00000X
OR200760019CRNA367500000X
OR20074175RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
No163W00000XNursing Service ProvidersRegistered Nurse