Vitality Functional Medicine LLC

Key facts

NPI

1821517954

Entity type

Organization (NPI type 2)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

201706673NP (OR)

Legal business name

VITALITY FUNCTIONAL MEDICINE LLC

Practice address

155 SW Century Dr Ste 111
Bend, OR 97702-1657

Phone

(458) 206-3331

Fax

(620) 506-4777

NPI assigned

Sep 9, 2017

Organization subpart

No

Authorized official

Name

Erin Arnold Bishop, GNP-BC, FNP-C NPI 1720165541

Title

Nurse Practitioner

Phone

(561) 676-6121

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Erin Arnold Bishop, ARNP-BC Nurse Practitioner · Bend, OR · NPI 1720165541
  NPD Authorized official
• Michelle A Hirschy, FNP Family Nurse Practitioner · Redmond, OR · NPI 1871923276
  NPD (past) FAMILY

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 17, 2018.

{
    "created_epoch": "1504915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1821517954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19657 ASPEN RIDGE DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023366",
            "telephone_number": "561-676-6121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 SW CENTURY DR STE 111",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021657",
            "telephone_number": "458-206-3331",
            "fax_number": "620-506-4777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19657 Aspen Ridge Dr",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977023366",
            "country_code": "US",
            "telephone_number": "561-676-6121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VITALITY FUNCTIONAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-09",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "ERIN",
        "authorized_official_middle_name": "ARNOLD",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "561-676-6121",
        "authorized_official_credential": "GNP-BC, FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201706673NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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