Search › Oregon › 363A00000X
Randall Kelly, MHS, DMSC, PA-C
NPI 1922393974 · on the registry since 2011
Practice
- Address
- 256 E Hurlburt Ave Ste 117
Hermiston, OR 97838 - Phone
- (541) 303-3558
- Fax
- (509) 593-4644
- Organisation at this address
- Perfectly Broken Llc
New Life Wellness LlcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 4
Additional practice sites
- 278 E High St Ste 209, Stayton, OR
- 71 Centennial Loop Ste A, Eugene, OR
- 761 Main St, Dallas, OR
- 1901 Garden Ave Ste 210, Eugene, OR
- 2900 Nw Clearwater Dr, Bend, OR
- 1817 Ne 6th Ave, Portland, OR
- 1110 Se Alder St Ste 301, Portland, OR
- 4909 S Coast Hwy Ste 1k, South Beach, OR
- 124 W Kennewick Ave Ste 11, Kennewick, WA
- 520 Nw 4th St, Corvallis, OR
- 1345 Nw 15th St, Lincoln City, OR
Registry record
- Primary taxonomy
- 363A00000X
363A00000X
- Also registered as
- 101YA0400X
363AM0700X
2083A0300X
363A00000X
2083A0300X - Licence states on file
- OR, WA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2026-03-27
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oregon