Kimberly Ann Talley, APRN
Individual provider Active NPI Family Nurse Practitioner · Roseburg, OR
NPI 1376277665 · NPPES record last updated Jul 15, 2022
Key facts
- NPI
- 1376277665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 905251 (MS)
- Practice address
- 2589 NW Edenbower Blvd
Roseburg, OR 97471-6224 - Phone
- (541) 529-9190
- NPI assigned
- Jul 12, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Waterfall Clinic Incorporated
Practice addresses (Care Compare)
1890 Waite St
North Bend, OR 97459-1229
Phone (541) 435-7033
755 S 7TH St
Coos Bay, OR 97420-1342
Phone (541) 756-6232
Hospital & facility affiliations
- Oregon Coast Home Health
- Bay Area Hospital
- Southern Coos Hospital & Health Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241009003566 | OR | Practitioner - Nurse Practitioner | 8921474206 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 905251 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Waterfall Clinic, Incorporated | Current |
Accepting new patients | |
| Cow Creek Band of Umpqua Tribe of Indians | Current |
Accepting new patients | |
| Waterfall Clinic, Incorporated | Current |
Accepting new patients | |
| Waterfall Clinic Incorporated | Current | Accepting new patients |
Locations
1890 Waite St
Ste 1
North Bend, OR 97459
Phone (541) 435-7033
Interoperability endpoints
- ktalley738790@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 905251 | MS | Yes |
Addresses
Primary practice location
2589 NW Edenbower Blvd
Roseburg, OR 97471-6224
Mailing address
311 Porter St
Senatobia, MS 38668-1919
Phone (662) 801-6117
Other providers in Roseburg, OR
- Eileen M Tabert
- Conner Tabor
- Kimberly Tabor
- Megan Taddei
- Rochelle Emma Taicz
- Travis Tuan Tang
- Kay Tanner
- Jason Tate
- Haeryun Kim Tatum
- Marshall Edward Tavares
All providers in Roseburg, OR · Family Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.