Kristyn Renee Prockish, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

10008017 Issued in OR

Practice address

62930 O B Riley Rd Ste 200
Bend, OR 97703-9459

Phone

(541) 330-1919

Fax

(833) 972-0672

NPI assigned

May 8, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optum Behavioral Care of Colorado, P.C.

  • Clinical Psychologist
  • Eugene, OR
  • NPI 1316717747
  Medicare reassignment NPD
• Optum Behavioral Care of Colorado, P.C.

  • Clinical Psychologist
  • Corvallis, OR
  • NPI 1861262297
  NPD
• Optum Behavioral Care of Colorado, P.C.

  • Clinical Psychologist
  • Seattle, WA
  • NPI 1114797545
  NPD
• Optum Behavioral Care of Colorado, P.C.

  • Clinical Social Worker
  • De Pere, WI
  • NPI 1396622494
  NPD
• Eugene Therapy LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Eugene, OR
  • NPI 1295065530
  NPD (past)

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

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1164112827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "399 E 10TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62930 O B RILEY RD STE 200",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977039459",
            "telephone_number": "541-330-1919",
            "fax_number": "833-972-0672"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12025 115th Ave NE Ste 200",
            "address_purpose": "LOCATION",
            "city": "Kirkland",
            "state": "WA",
            "postal_code": "980346935",
            "country_code": "US",
            "telephone_number": "425-821-1810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCKISH",
        "first_name": "KRISTYN",
        "middle_name": "RENEE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-08",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "10008017",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP70011033",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Vincent Prignano, PH.D.
• Jason Prinster, PH.D.
• Pro Motion Physical Therapy of Bend
• Proactive Health LLC
• Kristen Prochaska, MA, LPC
• Professionals Choice Medical Supplies and Special Transport
• Program Design Concepts, Inc
• Promotion Physical Therapy
• Prosthetics by Lynda Inc.
• Protean Dermatology Consulting, LLC

• Psychiatric/Mental Health Nurse Practitioner in Bend, OR
• Providers in Bend, 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 Sep 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.