Provider Demographics
NPI:1114752086
Name:ROYLYNN UNDERWOOD, PMHNP, LLC
Entity type:Organization
Organization Name:ROYLYNN UNDERWOOD, PMHNP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:ROYLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-NP
Authorized Official - Phone:503-819-1064
Mailing Address - Street 1:7737 OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-9717
Mailing Address - Country:US
Mailing Address - Phone:503-819-1064
Mailing Address - Fax:
Practice Address - Street 1:1744 E MCANDREWS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5576
Practice Address - Country:US
Practice Address - Phone:503-819-1064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty