Healthcare Provider Details

I. General information

NPI: 1174190946
Provider Name (Legal Business Name): AHOU BERTHE ARTERBURN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S WALL ST
COOS BAY OR
97420-3233
US

IV. Provider business mailing address

150 S WALL ST
COOS BAY OR
97420-3233
US

V. Phone/Fax

Practice location:
  • Phone: 541-435-7200
  • Fax: 541-888-0025
Mailing address:
  • Phone: 541-435-7200
  • Fax: 541-888-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5379736122
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021013558
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: