Healthcare Provider Details

I. General information

NPI: 1992783849
Provider Name (Legal Business Name): REBEKKAH ANNE KELLEY MN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2006
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SE 2ND ST
PENDLETON OR
97801-2224
US

IV. Provider business mailing address

331 SE 2ND ST
PENDLETON OR
97801-2224
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-6207
  • Fax: 541-276-4628
Mailing address:
  • Phone: 541-276-6207
  • Fax: 541-276-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30006960
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200750150NP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN00077263
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number200743615RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: