1760224331 NPI number — DR. K. BRANDI LACRE ND

Table of content: DR. K. BRANDI LACRE ND (NPI 1760224331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760224331 NPI number — DR. K. BRANDI LACRE ND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LACRE
Provider First Name:
K. BRANDI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ND
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LACRE
Provider Other First Name:
KATHARYN
Provider Other Middle Name:
BRANDI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ND
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760224331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2976 E STATE ST STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83616-6394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
385-743-2584
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 SW CENTURY DR STE 100-1079
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97702-3557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-977-7078
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1744R1102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172V00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374J00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 176B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP1600X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175T00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374J00000X , with the licence number: 110802 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 864218 . This is a "PCA-PDC (OHCC) PERSONAL CARE PROFESSIONAL CERTIFIED" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 865890 . This is a "IDD-PSW OREGON STATE PLAN PERSONAL CARE SERVICES (SPPC/84-800) OHA" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "PCD-POSTPARTUM DOULA (SIMKIN CENTER FOR ALLIED BIRTH VOCATIONS)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 864218 . This is a "MH-PC20 AMH-PERSONAL CARE SERVICES 20 (OREGON HEALTH AUTHORITY)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 868421 . This is a "HCW-PDC HOME CARE PROFESSIONAL CERTIFIED (OHCC)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "PWS-PEER WELLNESS SPECIALIST (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: THW000110802 . This is a "YSS-YOUTH SUPPORT SPECIALIST (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: THW000110802 . This is a "THW-TRADITIONAL HEALTH WORKER (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: THW000110802 . This is a "PSS-ADULT ADDICTIONS (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "CD-BIRTH DOULA (SIMKIN CENTER FOR ALLIED BIRTH VOCATIONS)" identifier . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "PSS-MENTAL HEALTH (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 865890 . This is a "PSW-EC (OHCC) PERSONAL SUPPORT ENHANCED CERTIFIED" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: COS-FT-10184774 . This is a "AESTHETICIAN (OHA-BOARD OF COSMETOLOGY)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "CRM-ADULT ADDICTIONS RECOVERY (MHACBO)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: THW000110802 . This is a "PSS-PEER SUPPORT SPECIALIST (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 868421 . This is a "HCW-AGING AND PEOPLE WITH DISABILITIES (ODHS)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "FSS-FAMILY SUPPORT SPECIALIST (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: THW000110802 . This is a "CHW-COMMUNITY HEALTH WORKER (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 864218 . This is a "BHPCA - OREGON MEDICAID BEHAVIORAL HEALTH PERSONAL CARE PROGRAM (OHA)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 868421 . This is a "HCW-EC HOME CARE ENHANCED CERTIFIED (OHCC)" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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