Healthcare Provider Details

I. General information

NPI: 1609286095
Provider Name (Legal Business Name): KIMBERLY D DELANEY, APRN, PSYD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 01/29/2022
Certification Date: 01/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SW BLUFF DR STE 220
BEND OR
97702-3220
US

IV. Provider business mailing address

255 SW BLUFF DR STE 220
BEND OR
97702-3220
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-3002
  • Fax: 888-972-6509
Mailing address:
  • Phone: 541-382-3002
  • Fax: 888-972-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number794
License Number StateHI

VIII. Authorized Official

Name: DR. KIMBERLY D DELANEY
Title or Position: PROVIDER/OWNER
Credential: PMHNP PSYD
Phone: 541-382-3002