Healthcare Provider Details

I. General information

NPI: 1497209928
Provider Name (Legal Business Name): KELLY LYNORE ROSENTHAL FINK PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY LYNORE ROSENTHAL APRN

II. Dates (important events)

Enumeration Date: 08/13/2016
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NW PROFESSIONAL DR
CORVALLIS OR
97330-3891
US

IV. Provider business mailing address

304 S JONES BLVD # 1654
LAS VEGAS NV
89107-2623
US

V. Phone/Fax

Practice location:
  • Phone: 458-272-1361
  • Fax:
Mailing address:
  • Phone: 702-721-9641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN002358
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10038846
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: