Provider Demographics
NPI:1225382617
Name:JUNIPER RIDGE DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
Entity Type:Organization
Organization Name:JUNIPER RIDGE DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:PADGETT
Authorized Official - Last Name:COEHLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, C-PNP PMHS CFLE
Authorized Official - Phone:541-323-5515
Mailing Address - Street 1:2275 NE DOCTORS DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6324
Mailing Address - Country:US
Mailing Address - Phone:541-323-5515
Mailing Address - Fax:
Practice Address - Street 1:62930 O B RILEY RD STE 300
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-9459
Practice Address - Country:US
Practice Address - Phone:541-323-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276739Medicaid