Individual
KIMBERLY K CANADAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, ANP
Contact information
Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Mailing address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200950116NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12460220
CAQH
OR
05
—
500672323
—
OR
Enumeration date
01/26/2010
Last updated
09/25/2014
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