Healthcare Provider Details

I. General information

NPI: 1174940753
Provider Name (Legal Business Name): KATHRYN JOHNSTON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN MARIE ROBERTS CNM

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 NE NEFF RD STE A
BEND OR
97701-6752
US

IV. Provider business mailing address

2400 NE NEFF RD STE A
BEND OR
97701-6752
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-3300
  • Fax: 541-389-8115
Mailing address:
  • Phone: 907-360-6119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number10036877
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2022015654
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1424
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: