Elizabeth Divine, DNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

10021024 Issued in OR

Practice address

1744 E McAndrews Rd Ste B
Medford, OR 97504-5576

Phone

(503) 965-0349

NPI assigned

May 5, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768262400000",
    "number": "1801479936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1744 E MCANDREWS RD STE B",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1744 E MCANDREWS RD STE B",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045576",
            "telephone_number": "503-965-0349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVINE",
        "first_name": "ELIZABETH",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-05",
        "last_updated": "2026-01-13",
        "certification_date": "2026-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "10021024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devin Dimond, DPM
• Heidi Annette Dirkse-Graw, LPC
• Marc Ditommaso, RPH
• Erin Marie Dittmer, NP
• Diversified Security Group
• Robert Neill Divine, BA
• Alanna R Dixon, PA-C
• Bren Dixon, D.M.D.
• Damon Dixon
• Megan Dixon

• Psychiatric/Mental Health Nurse Practitioner in Medford, OR
• Providers in Medford, 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 Jan 13, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.