KELLY BAUCUM LAC NPI 1104284736

NPI Information

  • NPI: 1104284736
  • Provider Name: KELLY BAUCUM, LAC
  • Classification: Acupuncturist - 171100000X
  • Entity Type: Individual
  • Address: 4605 NE FREMONT ST STE 103
    PORTLAND, OR
    ZIP 97213
  • Phone: (503) 395-5228

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NPI Details

Kelly Baucum, LAC is an acupuncturist in Portland, OR. The provider is an acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long, fine needles inserted into specific points in order to treat painful conditions or produce anesthesia. Kelly Baucum, LAC NPI is 1104284736. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4605 NE FREMONT ST STE 103
PORTLAND, OR
ZIP 97213-708
Phone: (503) 395-5228

The enumeration date for this NPI number is 2/10/2016 and was last updated on 2/10/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1171100000XAcupuncturistAC175542OREGONYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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