Provider Demographics
NPI:1255204129
Name:TRANSFORMATIONAL HEALING: REDISCOVER YOURSELF LLC
Entity type:Organization
Organization Name:TRANSFORMATIONAL HEALING: REDISCOVER YOURSELF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ-KONG
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:808-388-6277
Mailing Address - Street 1:555 SE MARTIN LUTHER KING JR BLVD UNIT 105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2595
Mailing Address - Country:US
Mailing Address - Phone:971-266-0177
Mailing Address - Fax:855-631-0578
Practice Address - Street 1:555 SE MARTIN LUTHER KING JR BLVD UNIT 105
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2595
Practice Address - Country:US
Practice Address - Phone:971-266-0177
Practice Address - Fax:855-631-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500745543Medicaid