KELLY D DEGOEDE (NPI# 1083183370) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083183370 |
| Entity Type | Individual |
| Full Name | KELLY D DEGOEDE |
| Credential | CRM |
| Practice Address |
1435 Ne 4th St Ste B Bend OR 97701-4268 |
| Practice Telephone | 5413064466 |
| Practice Fax Number | 5415502011 |
| Mailing Telephone | 5413064446 |
| Mailing Fax Number | 5035502011 |
| Enumeration Date | 2018-11-16 |
| Last Update Date | 2018-11-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | 18-CRM-353 | OR | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 18-CRM-353 | 05 |
| Street Address |
1435 NE 4TH ST STE B |
| City | BEND |
| State | OR |
| Zip Code | 97701-4268 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922585413 | Daniel Tovar | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2018-07-26 |
| 1922614130 | Kellie Rae Seems | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2020-09-22 |
| 1124633532 | Travis M Nelson | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2020-09-11 |
| 1609416627 | Paul L Roberts | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2020-01-07 |
| 1619516416 | Annie B Miller | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2019-12-27 |
| 1619514122 | David C Von Schlegell | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2019-12-03 |
| 1477196087 | Lynette Campbell | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2019-10-26 |
| 1134779481 | Nicole Webb | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2019-09-18 |
| 1184180002 | Kirsten Vantzelfden | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2019-02-15 |
| 1760951057 | Aliva L Duncan | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2018-11-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104465525 | Andrew Kyle Burzynski | Denturist | 853 Ne 4th St., Bend, OR 97701 | 2020-01-02 |
| 1013480714 | Andrew Traut | Specialist/Technologist | Oregon State Force Lab, 2200 Ne Neff Rd Suite 202, Bend, OR 97701 | 2019-01-04 |
| 1871063917 | Calley Asbill, Nd LLC | Chiropractor | 2146 Ne 4th Street, Suite 160, Bend, OR 97701 | 2018-12-02 |
| 1902372212 | Carisa S Battin | Counselor | 361 Ne Franklin Avenue Bldg E #4, Bend, OR 97701 | 2018-10-15 |
| 1366921223 | Hillside Eye Center LLC | Ophthalmology | 625 Nw Colorado Avenue, Bend, OR 97701 | 2018-08-11 |
| 1528545514 | Kellie Michiko Kawasaki-jones | Dentist | 62968 Ob Riley Road, Suite 12, Bend, OR 97701 | 2018-07-23 |
| 1992255327 | Shelby Chiropractic | Chiropractor | 561 Ne Bellevue Dr Ste 102, Bend, OR 97701 | 2016-10-10 |
| 1144671520 | Kevin Richard Pett | Acupuncturist | 39 Nw Louisanna Ave., Hawthorn Healing Arts Center, Bend, OR 97701 | 2016-06-27 |
| 1912357500 | Sheldon Shawn Doveri | Driver | 233 Nw Revere Ave, Bend, OR 97701 | 2016-06-15 |
| 1740647411 | Anne Power | Homeopath | 2100 Ne Neff Rd Suite B, Bend, OR 97701 | 2016-01-26 |
| Find all providers in zip 97701 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578162145 | Kenneth Branson | Peer Specialist | 389 Sw Scalehouse Ct Ste 130, Bend, OR 97702-3241 | 2020-10-23 |
| 1679188080 | Michelle Marie Bunkers | Peer Specialist | 20517 Jacklight Ln, Bend, OR 97702-2971 | 2020-09-11 |
| 1922585413 | Daniel Tovar | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2018-07-26 |
| 1194190652 | Breann M Flores | Peer Specialist | 1435 Ne 4th St Suite B, Bend, OR 97701 | 2015-12-09 |
| 1144821745 | Kristi L Schaffner | Peer Specialist | 389 Sw Scalehouse Ct Ste 130, Bend, OR 97702-3241 | 2020-11-02 |
| 1760083356 | Farrah Suzanne Carkhuff | Peer Specialist | 389 Sw Scalehouse Ct Ste 130, Bend, OR 97702-3241 | 2020-11-02 |
| 1982201737 | Kristie Galarza | Peer Specialist | 908 Ne 4th St Ste 101, Bend, OR 97701-4646 | 2020-10-05 |
| 1740887561 | Nickolas Petragallo | Peer Specialist | 908 Ne 4th St Ste 101, Bend, OR 97701-4646 | 2020-10-05 |
| 1922614130 | Kellie Rae Seems | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2020-09-22 |
| 1124633532 | Travis M Nelson | Peer Specialist | 1435 Ne 4th St Ste B, Bend, OR 97701-4268 | 2020-09-11 |
| Find all providers in BEND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.