Active NPI 1295245108 Individual Practitioner Female Practitioner

Davina Lynn Bledsoe , FNP-BC

Nurse Practitioner • Coos Bay, OR

✓ Accepts Medicare Assignment Telehealth Available

Professional Overview & Biography Verified Profile Summary

Davina Bledsoe, FNP-BC is a certified Nurse Practitioner practicing in Coos Bay, OR. With approximately 9 years of clinical experience since completing medical education in 2017, Davina Bledsoe delivers high-quality medical care to the local community at 1900 WOODLAND DR.

Davina Bledsoe maintains professional affiliations with Frontier Foot And Ankle Specialists Llc, North Bend Medical Center Inc and accepts Medicare assignment . Telehealth and virtual consultation options are available for eligible patients.

Frequently performed procedures and clinical services include established patient outpatient office visit, outpatient office visit, blood test, clotting time. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1900 Woodland Dr

Coos Bay, OR 974202099

Telephone 5412675151

Fax 5412664562

Associated Practice Facility / Clinic

🏢 North Bend Medical Center Inc Facility NPI 1407812365

Medicare Profile & Education

Medical School

Other

Graduation Year

2017

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

Telehealth Services Available

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner in Coos Bay, OR

Experienced Practitioner (5-10 Yrs)

Practitioner Clinical Experience

9 Yrs -1.8 yrs vs City Avg

City Avg: 10.8 Yrs

State Avg: 11.1 Yrs

Regional Practice Density

11 Specialists

Practicing in Coos Bay, OR (615 Statewide)

Telehealth Adoption Rate

27.3% Regional Adoption

✓ Offers Virtual Consultations

Medicare Pricing Discount

78.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Bledsoe (9 Years) 9 Yrs

Coos Bay Specialty Average (10.8 Years) 10.8 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	338	192	$407.28	$89.31
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	328	46	$100.00	$41.78
99213 Established patient office or other outpatient visit, typically 15 minutes	265	178	$258.38	$68.62
85610 Blood test, clotting time	243	37	$20.00	$4.20
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	239	239	$400.00	$52.21
96127 Assessment of emotional or behavioral problems	152	152	$14.82	$4.40
36415 Insertion of needle into vein for collection of blood sample	123	107	$6.94	$6.75
80053 Blood test, comprehensive group of blood chemicals	107	96	$75.00	$10.35
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	91	87	$35.00	$7.61
80061 Blood test, lipids (cholesterol and triglycerides)	65	64	$75.00	$12.92
84443 Blood test, thyroid stimulating hormone (TSH)	59	58	$70.00	$16.46
99497 Advance care planning, first 30 minutes	55	55	$300.00	$15.65
83021 Hemoglobin analysis and measurement, chromatography	49	48	$80.00	$17.70
90662 Influenza vaccine split virus, preservative free	32	32	$150.00	$76.88
99496 Transitional care management services for problem of high complexity	26	24	$600.00	$135.17
81001 Manual urinalysis test with examination using microscope, automated	22	18	$35.00	$3.11
99407 Smoking and tobacco use intensive counseling, more than 10 minutes	16	16	$150.00	$22.14
82043 Urine microalbumin (protein) level	14	14	$20.00	$5.26
82570 Creatinine level to test for kidney function or muscle injury	14	14	$25.00	$5.05
G0103 Prostate cancer screening; prostate specific antigen test (psa)	11	11	$45.00	$18.92

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
36415 Insertion of needle into vein for collection of blood sample	726	345	$6.00	$5.84
80053 Blood test, comprehensive group of blood chemicals	602	341	$75.00	$10.33
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	569	341	$35.00	$7.58
80061 Blood test, lipids (cholesterol and triglycerides)	410	319	$75.00	$13.12
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	409	251	$400.00	$88.50
84443 Blood test, thyroid stimulating hormone (TSH)	372	296	$70.00	$16.46
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	334	334	$400.00	$50.01
83021 Hemoglobin analysis and measurement, chromatography	318	214	$80.00	$17.70
99213 Established patient office or other outpatient visit, typically 15 minutes	314	210	$250.00	$68.96
99497 Advance care planning, first 30 minutes	297	293	$300.00	$19.23
93793 Anticoagulant management of patient taking warfarin	202	12	$25.00	$9.55
85610 Blood test, clotting time	202	26	$20.00	$4.20
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	189	34	$100.00	$39.09
81001 Manual urinalysis test with examination using microscope, automated	189	117	$35.00	$3.11
96127 Assessment of emotional or behavioral problems	163	161	$14.82	$4.47
82043 Urine microalbumin (protein) level	150	128	$20.00	$5.70
82570 Creatinine level to test for kidney function or muscle injury	150	128	$25.00	$5.09
90662 Influenza vaccine split virus, preservative free	120	115	$150.00	$71.56
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	112	11	$8.55	$1.11
G0103 Prostate cancer screening; prostate specific antigen test (psa)	48	48	$45.00	$18.92
82728 Ferritin (blood protein) level	39	25	$30.00	$12.83
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	39	39	$290.00	$281.77
84550 Uric acid level, blood	36	18	$20.00	$4.43
G0008 Administration of influenza virus vaccine	34	34	$57.76	$25.81
99407 Smoking and tobacco use intensive counseling, more than 10 minutes	34	31	$150.00	$22.27
99496 Transitional care management services for problem of high complexity	29	23	$600.00	$100.46
84155 Total protein level, blood	29	14	$15.00	$3.60
80069 Kidney function blood test panel	29	15	$25.00	$8.51
83540 Iron level	26	21	$25.00	$6.34
83550 Iron binding capacity	26	21	$40.00	$8.57
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	25	24	$140.00	$51.22
93000 Routine ekg using at least 12 leads including interpretation and report	21	18	$65.00	$11.93
82270 Stool analysis for blood to screen for colon tumors	20	20	$15.00	$4.29
84153 Psa (prostate specific antigen) measurement, total	18	17	$75.00	$18.02
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	16	16	$60.00	$20.28
82607 Cyanocobalamin (vitamin B-12) level	15	15	$50.00	$14.78

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
80053 Blood test, comprehensive group of blood chemicals	516	337	$75.00	$10.38
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	494	336	$35.00	$7.66
36415 Insertion of needle into vein for collection of blood sample	461	290	$6.00	$2.96
80061 Blood test, lipids (cholesterol and triglycerides)	427	323	$75.00	$13.13
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	419	263	$400.00	$76.99
99213 Established patient office or other outpatient visit, typically 15 minutes	387	243	$250.00	$64.64
84443 Blood test, thyroid stimulating hormone (TSH)	364	298	$70.00	$16.52
83021 Hemoglobin analysis and measurement, chromatography	321	222	$80.00	$17.72
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	273	273	$400.00	$44.05
85610 Blood test, clotting time	226	25	$20.00	$4.23
99497 Advance care planning, first 30 minutes	226	226	$300.00	$24.54
82043 Urine microalbumin (protein) level	225	190	$20.00	$5.67
82570 Creatinine level to test for kidney function or muscle injury	225	190	$25.00	$5.11
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	220	33	$100.00	$39.39
93793 Anticoagulant management of patient taking warfarin	204	11	$25.00	$9.36
81001 Manual urinalysis test with examination using microscope, automated	160	91	$35.00	$3.13
90662 Influenza vaccine split virus, preservative free	146	144	$150.00	$68.45
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	108	12	$8.55	$1.17
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	70	70	$290.00	$278.33
G0103 Prostate cancer screening; prostate specific antigen test (psa)	61	61	$45.00	$19.03
82728 Ferritin (blood protein) level	58	45	$30.00	$13.46
83550 Iron binding capacity	56	44	$40.00	$8.64
83540 Iron level	56	44	$25.00	$6.39
G0008 Administration of influenza virus vaccine	41	41	$57.76	$24.35
99443 Telephone medical discussion with physician, 21-30 minutes	31	22	$175.00	$106.20
82607 Cyanocobalamin (vitamin B-12) level	30	27	$50.00	$14.91
99407 Smoking and tobacco use intensive counseling, more than 10 minutes	30	29	$150.00	$23.39
93000 Routine ekg using at least 12 leads including interpretation and report	26	26	$65.00	$11.70
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	24	24	$60.00	$21.09
90670 Pneumococcal vaccine for injection into muscle	24	24	$450.00	$253.00
84153 Psa (prostate specific antigen) measurement, total	20	19	$75.00	$18.14
80069 Kidney function blood test panel	19	11	$25.00	$8.59
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	18	17	$140.00	$48.01
84100 Phosphate level	18	12	$18.00	$4.66
99496 Transitional care management services for problem of high complexity	18	14	$600.00	$93.08
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	15	15	$389.27	$119.04
99442 Telephone medical discussion with physician, 11-20 minutes	11	11	$150.00	$74.57

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
36415 Insertion of needle into vein for collection of blood sample	396	215	$5.91	$2.99
80053 Blood test, comprehensive group of blood chemicals	363	222	$67.22	$10.49
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	352	226	$31.55	$7.75
99213 Established patient office or other outpatient visit, typically 15 minutes	305	170	$230.49	$74.65
80061 Blood test, lipids (cholesterol and triglycerides)	271	204	$68.60	$13.34
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	263	155	$305.42	$107.54
84443 Blood test, thyroid stimulating hormone (TSH)	257	197	$63.67	$16.80
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	243	27	$73.66	$18.87
85610 Blood test, clotting time	211	18	$17.91	$4.29
83021 Hemoglobin analysis and measurement, chromatography	199	137	$73.08	$17.99
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	193	193	$353.96	$110.34
81001 Manual urinalysis test with examination using microscope, automated	107	59	$32.03	$3.17
82570 Creatinine level to test for kidney function or muscle injury	91	68	$22.80	$5.18
82043 Urine microalbumin (protein) level	88	68	$18.99	$5.75
90662 Influenza vaccine split virus, preservative free	71	71	$82.59	$65.26
99443 Telephone medical discussion with physician, 21-30 minutes	43	36	$138.75	$101.66
G0103 Prostate cancer screening; prostate specific antigen test (psa)	38	38	$43.25	$19.31
83540 Iron level	35	26	$22.67	$6.47
83550 Iron binding capacity	35	26	$35.61	$8.74
82728 Ferritin (blood protein) level	35	24	$27.61	$13.63
87086 Bacterial colony count, urine	33	18	$16.65	$8.07
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	32	30	$34.69	$20.44
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	30	30	$180.57	$120.94
G0008 Administration of influenza virus vaccine	30	30	$57.76	$14.23
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	26	21	$133.08	$45.52
90670 Pneumococcal vaccine for injection into muscle	26	26	$289.73	$241.38
87186 Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution	24	13	$17.82	$8.65
80069 Kidney function blood test panel	23	17	$22.24	$8.68
94760 Measurement of oxygen saturation in blood using ear or finger device	19	19	$5.32	$2.19
82607 Cyanocobalamin (vitamin B-12) level	19	16	$47.01	$15.08
99442 Telephone medical discussion with physician, 11-20 minutes	16	13	$111.97	$70.44
96127 Assessment of emotional or behavioral problems	15	15	$11.40	$4.52
84100 Phosphate level	15	13	$15.26	$4.74
84153 Psa (prostate specific antigen) measurement, total	13	11	$66.45	$18.39
96160 Administration and interpretation of patient-focused health risk assessment	12	12	$7.47	$2.26
G0009 Administration of pneumococcal vaccine	12	12	$57.76	$14.08

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
36415 Insertion of needle into vein for collection of blood sample	541	235	$4.74	$2.97
99213 Established patient office or other outpatient visit, typically 15 minutes	495	198	$200.00	$61.50
80053 Blood test, comprehensive group of blood chemicals	363	217	$21.84	$10.43
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	337	219	$16.05	$7.70
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	327	35	$50.00	$19.18
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	316	155	$275.00	$89.82
85610 Blood test, clotting time	257	25	$8.10	$4.25
80061 Blood test, lipids (cholesterol and triglycerides)	232	187	$27.69	$13.31
84443 Blood test, thyroid stimulating hormone (TSH)	229	180	$34.65	$16.70
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	195	195	$263.47	$96.07
83021 Hemoglobin analysis and measurement, chromatography	148	109	$36.95	$17.97
81001 Manual urinalysis test with examination using microscope, automated	109	58	$17.63	$3.13
99442 Telephone medical discussion with physician, 11-20 minutes	69	30	$63.08	$53.74
87086 Bacterial colony count, urine	59	35	$16.65	$7.92
82043 Urine microalbumin (protein) level	50	42	$11.93	$5.74
90662 Influenza vaccine split virus, preservative free	49	49	$57.04	$54.20
82570 Creatinine level to test for kidney function or muscle injury	48	42	$10.67	$5.15
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	40	40	$30.00	$19.51
87186 Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution	36	25	$17.82	$8.14
99443 Telephone medical discussion with physician, 21-30 minutes	35	26	$92.96	$89.32
G0008 Administration of influenza virus vaccine	35	35	$57.76	$16.52
80069 Kidney function blood test panel	31	14	$17.95	$8.63
87088 Bacterial urine culture	31	23	$19.46	$7.85
82728 Ferritin (blood protein) level	23	18	$18.03	$13.61
83550 Iron binding capacity	23	18	$18.03	$8.50
83540 Iron level	23	18	$13.35	$6.29
84100 Phosphate level	19	15	$9.78	$4.72
93000 Routine ekg using at least 12 leads including interpretation and report	17	17	$36.48	$14.11
G0103 Prostate cancer screening; prostate specific antigen test (psa)	17	17	$30.89	$19.26
82607 Cyanocobalamin (vitamin B-12) level	13	13	$31.08	$14.16
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	11	11	$389.27	$138.35

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	763	240	$200.00	$61.57
36415 Insertion of needle into vein for collection of blood sample	459	179	$4.50	$2.94
80053 Blood test, comprehensive group of blood chemicals	304	155	$21.80	$11.51
85610 Blood test, clotting time	300	19	$8.10	$4.28
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	248	139	$16.05	$8.46
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	227	20	$50.00	$18.79
80061 Blood test, lipids (cholesterol and triglycerides)	168	122	$27.65	$14.58
84443 Blood test, thyroid stimulating hormone (TSH)	151	116	$34.65	$18.30
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	122	122	$169.00	$96.16
83021 Hemoglobin analysis and measurement, chromatography	120	76	$36.95	$19.66
81001 Manual urinalysis test with examination using microscope, automated	74	36	$17.63	$3.45
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	43	41	$30.00	$18.65
87086 Bacterial colony count, urine	41	21	$16.65	$8.79
93000 Routine ekg using at least 12 leads including interpretation and report	34	32	$36.75	$13.76
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	30	23	$275.00	$90.45
71046 X-ray of chest, 2 views	30	28	$75.53	$18.53
90662 Influenza vaccine split virus, preservative free	22	22	$56.01	$54.89
82043 Urine microalbumin (protein) level	21	15	$11.93	$6.29
82570 Creatinine level to test for kidney function or muscle injury	21	15	$10.67	$5.63
90670 Pneumococcal vaccine for injection into muscle	17	17	$240.00	$209.84
84439 Thyroxine (thyroid chemical), free	13	11	$18.60	$9.82
G0009 Administration of pneumococcal vaccine	13	13	$57.76	$16.19
G0396 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes	13	12	$7.93	$7.84
G0008 Administration of influenza virus vaccine	11	11	$57.76	$16.19

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	357	200	$200.00	$59.35
36415 Insertion of needle into vein for collection of blood sample	160	79	$4.50	$2.94
80053 Blood test, comprehensive group of blood chemicals	103	60	$21.80	$12.78
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	80	59	$16.05	$9.40
80061 Blood test, lipids (cholesterol and triglycerides)	49	46	$27.65	$16.20
83021 Hemoglobin analysis and measurement, chromatography	47	39	$36.95	$21.84
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	44	20	$275.00	$87.84
84443 Blood test, thyroid stimulating hormone (TSH)	42	39	$34.65	$20.33
81001 Manual urinalysis test with examination using microscope, automated	29	26	$17.63	$3.84
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	27	27	$350.00	$120.79
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	26	26	$500.00	$166.63
87086 Bacterial colony count, urine	22	21	$16.65	$9.76
71046 X-ray of chest, 2 views	14	13	$75.53	$17.46
93000 Routine ekg using at least 12 leads including interpretation and report	13	12	$41.04	$14.05

Medical Specialties & State Licenses

CMS Verified: 2025-10-02

Nurse Practitioner Primary Specialty

NUCC Taxonomy Code: 363L00000X

State License OR 201800261NP-PP

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

500740413 (OR)

Hospital & Practice Group Affiliations

North Bend Medical Center Inc

1900 Woodland Dr, Coos Bay, OR 974202045

Phone: 5412675151

North Bend Medical Center Inc

1900 Woodland Dr, Coos Bay, OR 974202045

Phone: 5412675151

Frontier Foot And Ankle Specialists Llc

780 2nd St Se, Bandon, OR 974118354

Phone: 5413292555

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

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Pediatrics

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Doctor of Medicine (M.D.)

Dr. Sharon Monsivais , MD

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Doctor of Medicine (M.D.)

Dr. Donna Rabin , MD

Pediatrics

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Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

12 Historical Events

📍

Updated Practice Location October 02, 2025

Registered at 1900 WOODLAND DR, COOS BAY, OR 974202099 (Tel: 5412675151)

📍

Updated Business Mailing Address October 02, 2025

Registered at 1900 WOODLAND DR, COOS BAY, OR 974202099 (Tel: 5412675151)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) February 20, 2025

Nurse Practitioner (License #201800261NP-PP in OR)

📍

Updated Practice Location April 09, 2020

Registered at 1750 THOMPSON RD, COOS BAY, OR 974202195 (Tel: 5412690333)

👤

Provider Name / Credentials Updated April 09, 2020

Recorded as DAVINA BLEDSOE, FNP-BC

📍

Updated Business Mailing Address March 13, 2018

Registered at 1750 THOMPSON RD, COOS BAY, OR 974202100 (Tel: 5412690333)

✅

NPI Profile Active October 05, 2017

NPI status registered as active in NPPES database

📍

Updated Practice Location October 05, 2017

Registered at 1772 SW PALERMO RD, PORT SAINT LUCIE, FL 34987 (Tel: 2548330892)

📍

Updated Business Mailing Address October 05, 2017

Registered at 1772 SW PALERMO RD, PORT ST LUCIE, FL 349872210 (Tel: 2548330892)

👤

Provider Name / Credentials Updated October 05, 2017

Recorded as DAVINA BLEDSOE, ARNP

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) October 05, 2017

Family Medicine (License #ARNP9378600 in FL)

🟢

Initial NPI Registration & Enumeration October 05, 2017

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1295245108

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: October 05, 2017

Last Update: October 02, 2025

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

1900 Woodland Dr

Coos Bay, OR 974202099

Phone: 5412675151

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.