Active NPI
Mary Kate Coppedge, RN,PMHNP-BC, MSN
- Psychiatric/Mental Health Nurse Practitioner
- Bend, OR
National Provider Identifier
1194057661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 201050015NP
- Practice address
- 2577 NE Courtney Dr
Bend, OR 97701-7638 - Phone
- (541) 322-7500
- Fax
- (541) 322-7565
- NPI assigned
- Feb 8, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 201050015NP | OR | Primary |
Addresses
Primary practice location
2577 NE Courtney Dr
Bend, OR 97701-7638
Mailing address
2577 NE Courtney Dr
Bend, OR 97701-7638
Phone (541) 322-7500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2023 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science - Nursing, Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201050015NP | OR | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355184000000",
"number": "1194057661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2577 NE COURTNEY DR",
"city": "BEND",
"state": "OR",
"postal_code": "977017638",
"telephone_number": "541-322-7500",
"fax_number": "541-322-7565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2577 NE COURTNEY DR",
"city": "BEND",
"state": "OR",
"postal_code": "977017638",
"telephone_number": "541-322-7500",
"fax_number": "541-322-7565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COPPEDGE",
"first_name": "MARY KATE",
"name_prefix": "Mrs.",
"credential": "RN,PMHNP-BC, MSN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-08",
"last_updated": "2012-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "OR",
"license": "201050015NP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.