New Life Wellness LLC

Primary specialty

Addiction Medicine (Preventive Medicine) PhysicianTaxonomy code 2083A0300X

Legal business name

NEW LIFE WELLNESS LLC

Practice address

256 E Hurlburt Ave Ste 117
Hermiston, OR 97838-2443

Phone

(541) 303-3558

Fax

(509) 593-4644

NPI assigned

Oct 1, 2020

Last updated

Jun 10, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Randall Kelly, DMSC PAC MHSNPI 1922393974

Title

Physician Assistant, Owner

Phone

(206) 418-8222

Specialties & licenses 6

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Randall Douglas Kelly, MHS, DMSC, PA-C

  • Physician Assistant
  • Hermiston, OR
  • NPI 1922393974

  WA

  Medicare reassignment Authorized official
• Mindy Tanimoto, ARNP, FNP-BC

  • Family Nurse Practitioner
  • Kennewick, WA
  • NPI 1043767122
  NPD

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

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781049600000",
    "number": "1508463639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5426 ROAD 68 STE D253",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993015268",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 E HURLBURT AVE STE 117",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978382443",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4909 S Coast Hwy Ste 1K",
            "address_purpose": "LOCATION",
            "city": "South Beach",
            "state": "OR",
            "postal_code": "973669667",
            "country_code": "US",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2900 NW Clearwater Dr",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977039410",
            "country_code": "US",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "124 W Kennewick Ave Ste 11",
            "address_purpose": "LOCATION",
            "city": "Kennewick",
            "state": "WA",
            "postal_code": "993363830",
            "country_code": "US",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "520 NW 4th St",
            "address_purpose": "LOCATION",
            "city": "Corvallis",
            "state": "OR",
            "postal_code": "973306411",
            "country_code": "US",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1901 Garden Ave Ste 210",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974034301",
            "country_code": "US",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "761 Main St",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "OR",
            "postal_code": "973383108",
            "country_code": "US",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1345 NW 15th St",
            "address_purpose": "LOCATION",
            "city": "Lincoln City",
            "state": "OR",
            "postal_code": "973673327",
            "country_code": "US",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1110 SE Alder St Ste 301",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972142400",
            "country_code": "US",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "278 E High St Ste 209",
            "address_purpose": "LOCATION",
            "city": "Stayton",
            "state": "OR",
            "postal_code": "973831788",
            "country_code": "US",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "71 Centennial Loop Ste A",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974012443",
            "country_code": "US",
            "telephone_number": "541-303-3558",
            "fax_number": "509-593-4644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NEW LIFE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-01",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT, OWNER",
        "authorized_official_telephone_number": "206-418-8222",
        "authorized_official_credential": "DMSC PAC MHS"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "randall@newlifewell.com",
            "affiliation": "N",
            "address_1": "4909 S Coast Hwy Ste K",
            "city": "South Beach",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973669648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Addiction Medicine (Preventive Medicine) Physician in Hermiston, OR
• Providers in Hermiston, OR by specialty
• Addiction Medicine (Preventive Medicine) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.