MR. BRIAN BENNETT KOLDYKE (NPI# 1609203363) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609203363 |
| Entity Type | Individual |
| Full Name | MR. BRIAN BENNETT KOLDYKE |
| Credential | MSN, FNP-C |
| Practice Address |
51600 Huntington Rd La Pine OR 97739-8887 |
| Mailing Address |
Po Box 3300 La Pine OR 97739-3300 |
| Practice Telephone | 5415363435 |
| Practice Fax Number | 5415368047 |
| Mailing Telephone | 5415363435 |
| Mailing Fax Number | 5415368047 |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2017-03-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
5850890-4405 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
201392747NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
51600 HUNTINGTON RD |
| City | LA PINE |
| State | OR |
| Zip Code | 97739-8887 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912904202 | Martin Lindsey Smart | Family Medicine | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2005-07-01 |
| 1285245761 | Deborah Butcher | Licensed Practical Nurse | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2020-08-10 |
| 1538779301 | Marc Grayson Lewis | Registered Nurse | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2020-08-05 |
| 1922644640 | Kevin Christy | Pharmacist | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2019-11-18 |
| 1053973099 | Brianne Kanehl | Nurse Practitioner | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2019-06-30 |
| 1932609369 | Rachel Gonce | Registered Nurse | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2018-02-12 |
| 1265931000 | Hallie Rebecca Whinnery | Registered Nurse | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2018-02-07 |
| 1114436672 | Thomas Ryan Giles | Physician Assistant | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2017-09-27 |
| 1184146417 | Beth Ellen Erickson | Social Worker | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2017-07-07 |
| 1194180562 | Janice Cody | Nurse Practitioner | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2015-12-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174910897 | Hannah Noble | Occupational Therapist | 51340 Highway 97 # Or97739, La Pine, OR 97739 | 2015-04-21 |
| 1093145484 | Holly Lassen | Counselor | 51530 Huntington Rd Ste 5, La Pine, OR 97739 | 2013-11-20 |
| 1487899183 | Jennifer Ann Slater | Specialist | 16639 Box Way, Suite A, La Pine, OR 97739 | 2008-12-09 |
| 1003082652 | Jonathan Yang | Dentist | 16475 Bluewood Pl, Lapine, OR 97739 | 2008-05-05 |
| 1104943521 | Total Vision, Inc. | Technician/Technologist | 16487 Bluewood Place, Suite 2, La Pine, OR 97739 | 2007-03-22 |
| 1831243286 | Ronald Otto Nowack | Chiropractor | 16410 3rd St, Ste A, La Pine, OR 97739 | 2007-01-23 |
| 1477613313 | David Kimlin Dunscombe | Dentist | 16440 3rd Street, La Pine, OR 97739 | 2006-12-11 |
| 1740349430 | Joannie J Miller | Nurse Practitioner | 51375 S Huntington Rd, La Pine, OR 97739 | 2006-12-08 |
| 1285677575 | Brice Tyler Stanley | Physician Assistant | 5600 Huntington Rd, Lapine Community Clinic, Lapine, OR 97739 | 2006-06-14 |
| 1922072909 | High Desert Therapy Associates Inc | Hospice Care, Community Based | 51681 Huntington Road, La Pine, OR 97739 | 2006-02-15 |
| Find all providers in zip 97739 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922493246 | Joanna Mccabe | Nurse Practitioner | 51375 Huntington Rd, La Pine, OR 97739-9625 | 2015-04-02 |
| 1285050062 | Kristina Timmons | Nurse Practitioner | 52726 Ammon Rd, La Pine, OR 97739-7659 | 2014-03-17 |
| 1184784332 | Paulina Peak Family Healthcare Inc | Nurse Practitioner | 51384 Highway 97, La Pine, OR 97739-9871 | 2006-12-11 |
| 1740349430 | Joannie J Miller | Nurse Practitioner | 51375 S Huntington Rd, La Pine, OR 97739 | 2006-12-08 |
| 1053973099 | Brianne Kanehl | Nurse Practitioner | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2019-06-30 |
| 1548794092 | Paulina Peaks Family Healthcare | Nurse Practitioner | 51375 Huntington Rd, La Pine, OR 97739-9625 | 2017-04-11 |
| 1194180562 | Janice Cody | Nurse Practitioner | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2015-12-29 |
| 1962883140 | Rita Goehring | Nurse Practitioner | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2015-06-14 |
| 1639593874 | Christina Farleigh | Nurse Practitioner | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2014-02-07 |
| 1639450471 | Denise Lee Griffiths | Nurse Practitioner | 51600 Huntington Rd, La Pine, OR 97739-8887 | 2011-09-07 |
| Find all providers in LA PINE | ||||
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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.