CORVALLIS PEDIATRICS, LLC
NPI 1720979651
Clinic/Center - Primary Care in Corvallis, OR
About Corvallis Pediatrics, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CORVALLIS PEDIATRICS, LLC (NPI 1720979651) is a healthcare organization registered as a primary care in Corvallis, Oregon and active in the NPI registry since July 2025. The organization holds a CLIA Waiver certificate valid through September 29, 2027 and lists Kourtney Hanks, Nurse Practitioner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 38D2331389
Corvallis Pediatrics · Corvallis, OROther Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Corvallis Pediatrics, LLC's NPI number?
The NPI number for Corvallis Pediatrics, LLC is 1720979651. It was assigned to this organization in the NPPES registry on July 10, 2025.
Where is Corvallis Pediatrics, LLC located?
Corvallis Pediatrics, LLC is located at 1873 NW Kings Blvd, Corvallis, OR 97330. The listed phone number is (541) 745-8715.
What is Corvallis Pediatrics, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Does Corvallis Pediatrics, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 38D2331389) is associated with this NPI, valid through September 29, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Corvallis Pediatrics, LLC was last updated on July 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Corvallis Pediatrics, Llc · NPI 1720979651
Primary Care organization in Corvallis, Oregon. Organization record, active in the CMS NPPES registry since July 10, 2025.
## Identity
- **NPI:** 1720979651 (Entity type: Organization)
- **Enumerated:** July 10, 2025
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Kourtney Hanks, NURSE PRACTITIONER
## Practice location
- **Address:** 1873 NW KINGS BLVD, Corvallis, OR 97330-1907
- **Phone:** (541) 745-8715
## Record status
- **NPPES last updated:** July 10, 2025
- **Other identifiers:** Medicaid 1013371707 (OR)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1720979651) · Data from the CMS NPPES public registry.