Individual
KELLY DIANE HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, PMHNP
Contact information
Practice address
331 GOODPASTURE ISLAND RD, EUGENE, OR 97401-2109
(541) 636-9846
(541) 636-9847
Mailing address
331 GOODPASTURE ISLAND RD, EUGENE, OR 97401-2109
(541) 636-9846
(541) 636-9847
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200942615RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201150087NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500644984
—
OR
Enumeration date
02/03/2011
Last updated
08/07/2023
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