Colleen Bettilyen Davenport, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

201909237NP-PP Issued in OR

Practice address

3425 13TH St
Baker City, OR 97814-1340

Phone

(541) 523-7400

Fax

(253) 584-1508

NPI assigned

Jul 16, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648166400000",
    "number": "1003223694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 13TH ST",
            "city": "BACKER CITY",
            "state": "OR",
            "postal_code": "978141340",
            "telephone_number": "541-523-7400",
            "fax_number": "541-523-4927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3425 13TH ST",
            "city": "BAKER CITY",
            "state": "OR",
            "postal_code": "978141340",
            "telephone_number": "541-523-7400",
            "fax_number": "253-584-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "COLLEEN",
        "middle_name": "BETTILYEN",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-16",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60443726",
            "primary": false
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "WA",
            "license": "AP60443726",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201909237NP-PP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500770467",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan M Crompton, RPH
• Michael R Cross, DMD
• Joelle Renee Crowther
• Suzann Culbertson, CADC I
• Abagail I Dailey
• Deeann K Davis, LCSW
• Desiree Davis, COTA
• James E Davis, M.D.
• John T Davis, LCSW
• Leah Kathleen Day

• Psychiatric/Mental Health Nurse Practitioner in Baker City, OR
• Providers in Baker City, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.