Individual
KELLIE MARIE CREASER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP, PMHNP-BC, FNP-C
Contact information
Practice address
648 CHETCO AVE, BROOKINGS, OR 97415-8010
(541) 351-9149
(503) 914-6686
Mailing address
840 HASSETT ST, BROOKINGS, OR 97415-7201
(541) 351-9149
(503) 914-6686
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
201908534NP-PP
OR
363LF0000X
Family Nurse Practitioner
201908534NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201908534NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801662598
AVANT MENTAL HEALTH NPI
OR
05
—
500771078
—
OR
Enumeration date
10/03/2019
Last updated
07/22/2025
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