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SID CHRISTIAN KEOMANIVONG
NPI 1760960462
Nurse Practitioner - Primary Care in Central Point, OR

Active since August 03, 2018
2677 BEALL LN, CENTRAL POINT, OR 97502(702) 343-0466 Get Directions Write a Review

NPPES record last updated: October 8, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Oct 8, 2019, Aug 3, 2018 (2 updates tracked since 2018).

About Sid Christian Keomanivong NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SID CHRISTIAN KEOMANIVONG (NPI 1760960462) is an individual primary care provider in Central Point, Oregon, licensed in Oregon (201806379NP-PP) and active in the NPI registry since August 2018.

NPPES Registry Identity

NPI1760960462
Entity TypeIndividualMale
Primary Taxonomy363LP2300X
Provider Legal NameSID CHRISTIAN KEOMANIVONG
Location Address2677 BEALL LNCentral Point, OR 97502-1462
Mailing Address3344 Winterhaven St, Unit 101Las Vegas, NV 89108-5064 · (702) 343-0466
Phone(702) 343-0466
Sole ProprietorNo
Enumeration DateAugust 3, 2018
Last NPPES UpdateOctober 8, 20192 updates tracked since enumeration
✔ NPI 1760960462 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
License✔ Licensed in OR · 201806379NP-PP
2677 BEALL LN, Central Point, OR 97502
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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 Sid Keomanivong's NPI number?

The NPI number for Sid Keomanivong is 1760960462. It was assigned to this individual provider in the NPPES registry on August 3, 2018.

Where is Sid Keomanivong located?

Sid Keomanivong practices at 2677 Beall Ln, Central Point, OR 97502. The listed phone number is (702) 343-0466.

What is Sid Keomanivong's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

When was this NPI record last updated?

The NPPES record for Sid Keomanivong was last updated on October 8, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.