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General NPI Number Information
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NPI Number | 1801521414
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Entity Type | Individual
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Provider Name | ELIZABETH ANN BERNARDY CM II
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Gender | Female
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 1115 HAR-BER RD
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City | GROVE
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State | OK
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Zip | 74344
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Country | US
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Telephone | 844-458-2100
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Fax | 918-796-4435
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Provider Business Mailing Address
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Address Line | 3425 13TH ST
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City | BAKER CITY
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State | OR
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Zip | 97814-1340
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Country | US
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Telephone | 541-523-7400
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Fax | 541-523-4927
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 22-QMHA-R-2935
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 22-CRM-114
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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