Healthcare Provider Details

I. General information

NPI: 1922180777
Provider Name (Legal Business Name): DEBORAH PADGETT COEHLO PHD, C-PNP, PMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62930 O B RILEY RD STE 300
BEND OR
97703-9459
US

IV. Provider business mailing address

62930 O B RILEY RD STE 300
BEND OR
97703-9459
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-5515
  • Fax: 541-323-3505
Mailing address:
  • Phone: 541-323-5515
  • Fax: 541-323-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number000039320N2PNP-PP
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier271240
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerMEDICARE
# 2
Identifier276739
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 3
Identifier271240
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: