Healthcare Provider Details

I. General information

NPI: 1831425255
Provider Name (Legal Business Name): CHRISTYN RENEE KING CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 12/04/2025
Certification Date:
Deactivation Date: 11/18/2025
Reactivation Date: 12/04/2025

III. Provider practice location address

464 NE NORTON AVE
BEND OR
97701-4387
US

IV. Provider business mailing address

1235 NE 9TH ST
BEND OR
97701-4440
US

V. Phone/Fax

Practice location:
  • Phone: 541-318-6961
  • Fax: 541-389-5345
Mailing address:
  • Phone: 541-610-2450
  • Fax: 541-389-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM-LV-10132774
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: