Provider Demographics
NPI:1922180777
Name:COEHLO, DEBORAH PADGETT (PHD, C-PNP, PMHS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:PADGETT
Last Name:COEHLO
Suffix:
Gender:F
Credentials:PHD, C-PNP, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62930 O B RILEY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-9459
Mailing Address - Country:US
Mailing Address - Phone:541-323-5515
Mailing Address - Fax:541-323-3505
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:541-323-3505
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000039320N2PNP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271240OtherMEDICARE
OR276739Medicaid
OR271240Medicaid