Provider Demographics
NPI:1720280571
Name:DELANEY, KIMBERLY D (MN, PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:D
Last Name:DELANEY
Suffix:
Gender:F
Credentials:MN, PSYD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:DELANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MN, PSYD
Mailing Address - Street 1:255 SW BLUFF DR STE 220
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3220
Mailing Address - Country:US
Mailing Address - Phone:541-382-3002
Mailing Address - Fax:888-972-6509
Practice Address - Street 1:255 SW BLUFF DR STE 220
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3220
Practice Address - Country:US
Practice Address - Phone:541-382-3002
Practice Address - Fax:888-972-6509
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2164103T00000X
OR093000164RN163WP0808X
HI56321163WP0809X
OR093000164N6 PMHNP-PP363LP0808X
HI794363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult