Provider Demographics
NPI:1649835208
Name:NESBITT, KARLY JANE (PA-C)
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:JANE
Last Name:NESBITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARLY
Other - Middle Name:JANE
Other - Last Name:RUDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:20602 COVENTRY CIR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9448
Mailing Address - Country:US
Mailing Address - Phone:561-385-5363
Mailing Address - Fax:
Practice Address - Street 1:2200 NE NEFF RD STE 302
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4279
Practice Address - Country:US
Practice Address - Phone:541-706-6915
Practice Address - Fax:541-706-6733
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant