Healthcare Provider Details

I. General information

NPI: 1902671415
Provider Name (Legal Business Name): KELSEY SEXTON ANDERSON RN; APRN; PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2197 NE CASTLE AVE
BEND OR
97701-8768
US

IV. Provider business mailing address

2197 NE CASTLE AVE
BEND OR
97701-8768
US

V. Phone/Fax

Practice location:
  • Phone: 310-427-4190
  • Fax:
Mailing address:
  • Phone: 310-427-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1000566-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10055316
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number1679468
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number10055316
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: