MEDICARE: DEEP INSIGHT PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1285414425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEEP INSIGHT PLLC

Provider Business Mailing Address
First Line	:	6400 SE LAKE RD STE 135
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97222-2189
Country	:	US
Telephone Number	:	971-358-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 NW SHEVLIN PARK RD STE 120
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-7134
Country	:	US
Telephone Number	:	541-241-2509
Fax Number	:	888-850-5616

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	JILL ANN CARTER
Credential	:
Telephone Number	:	360-601-8552

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	05/01/2025

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Directions to “DEEP INSIGHT PLLC ” Practice Location

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