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NPI Code Detail

MEDICARE: KELLY ANGELA OVERDORF

MEDICARE: KELLY ANGELA OVERDORF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorL1234OR

General Provider Information

NPI Number : 1053907444
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ANGELA OVERDORF
Provider Business Mailing Address
First Line : 2577 NE COURTNEY DR
Second Line :
City : BEND
State : OR
Zip : 97701-7752
Country : US
Telephone Number : 541-322-7500
Fax Number : 541-322-7565
Provider Business Practice Location Address
First Line : 1340 NW WALL ST
Second Line :
City : BEND
State : OR
Zip : 97703-1985
Country : US
Telephone Number : 541-322-7500
Fax Number : 541-322-7565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2020
Last Update Date : 01/08/2026

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Directions to “ KELLY ANGELA OVERDORF ” Practice Location

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