Healthcare Provider Details

I. General information

NPI: 1669085270
Provider Name (Legal Business Name): TENEISHA C KAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VIRGINIA AVE STE 100
NORTH BEND OR
97459-3477
US

IV. Provider business mailing address

PO BOX 1121
ROSEBURG OR
97470-0254
US

V. Phone/Fax

Practice location:
  • Phone: 541-490-2022
  • Fax: 844-847-8136
Mailing address:
  • Phone: 541-672-2691
  • Fax: 541-673-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201805758RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: