NPIMap

Organization Active NPI

Vitality Functional Medicine LLC

  • Family Nurse Practitioner
  • Bend, OR
National Provider Identifier
1821517954
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201706673NP Issued in 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
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Erin Arnold Bishop, GNP-BC, FNP-CNPI 1720165541
Title
Nurse Practitioner
Phone
(561) 676-6121

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 201706673NP OR Primary

Addresses

Primary practice location

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

Mailing address

19657 Aspen Ridge Dr
Bend, OR 97702-3366
Phone (561) 676-6121

Other practice location 1

19657 Aspen Ridge Dr
Bend, OR 97702-3366
Phone (561) 676-6121

National Provider Directory

National Provider Directory

Locations

155 SW Century Dr
Ste 111
Bend, OR 97702
Phone (541) 318-4700

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "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": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201706673NP",
            "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 Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.