Healthcare Provider Details

I. General information

NPI: 1891286944
Provider Name (Legal Business Name): JADE CARBOY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 04/07/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 NW LOUISIANA AVE
BEND OR
97703-3310
US

IV. Provider business mailing address

39 NW LOUISIANA AVE
BEND OR
97703-3310
US

V. Phone/Fax

Practice location:
  • Phone: 541-330-0334
  • Fax:
Mailing address:
  • Phone: 541-330-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG05180071
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number104418853
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: