Healthcare Provider Details

I. General information

NPI: 1700146073
Provider Name (Legal Business Name): AMANDA KEETON HAMER MS, CHW, FSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NE HAWTHORNE AVE
BEND OR
97701-4690
US

IV. Provider business mailing address

PO BOX 1481
BEND OR
97709-1481
US

V. Phone/Fax

Practice location:
  • Phone: 541-678-2704
  • Fax:
Mailing address:
  • Phone: 541-678-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: