Provider Demographics
NPI:1174119895
Name:ECKERT, ALLISON (ARNP-NP, DNP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:ECKERT
Suffix:
Gender:F
Credentials:ARNP-NP, DNP
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 70779
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475-0137
Mailing Address - Country:US
Mailing Address - Phone:541-345-1722
Mailing Address - Fax:541-485-7049
Practice Address - Street 1:66 CLUB RD STE 160
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2439
Practice Address - Country:US
Practice Address - Phone:541-345-1722
Practice Address - Fax:541-485-7049
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9551647163WP0808X
FL11010979363LP0808X
OR10009410APRN-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
15077443OtherCAQH
OR500821712Medicaid