Keely Aubrey Petersen-Snider, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

201050176NP Issued in OR

Practice address

3156 State St
Medford, OR 97504

Phone

(541) 476-2373

NPI assigned

Sep 18, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peacehealth

  • Multi-Specialty Clinic/Center
  • Florence, OR
  • NPI 1982774378
  Medicare reassignment NPD
• Options Counseling Services of Oregon

  • Mental Health Counselor
  • Eugene, OR
  • NPI 1548275217
  NPD (past)

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540166400000",
    "number": "1902092547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 SW G ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975262544",
            "telephone_number": "541-476-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3156 STATE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97504",
            "telephone_number": "541-476-2373"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "340 9th Street",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "OR",
            "postal_code": "974394575",
            "country_code": "US",
            "telephone_number": "541-997-6085",
            "fax_number": "541-902-9702",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "175 W B St Ste D",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OR",
            "postal_code": "974774575",
            "country_code": "US",
            "telephone_number": "541-762-1971",
            "fax_number": "541-762-1974",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "175 W B St Ste D",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OR",
            "postal_code": "974774575",
            "country_code": "US",
            "telephone_number": "541-762-1971",
            "fax_number": "541-762-1974",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN-SNIDER",
        "first_name": "KEELY",
        "middle_name": "AUBREY",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-18",
        "last_updated": "2018-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IA",
            "license": "073586",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201050176NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer M Perry, M.D.
• Karen Irene Perry
• Lindsey Michelle Persinger
• Pete Bell, LCSW, Inc.
• Peter a Grant MD PC
• Christine Ann Petersen, M.D.
• John J Petersen, PA
• Ashley Daisy Peterson-Briggs, MD
• Adam Peterson, CADC III, CSWA
• Anna Peterson

• 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 Oct 22, 2018; 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.