MEDICARE: CORINNE A REKART PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61125788	WA
2	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	201341636RN	OR
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	202010541NP-PP	OR

General Provider Information

NPI Number	:	1598895013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNE A REKART PMHNP-BC

Provider Business Mailing Address
First Line	:	2705 E BURNSIDE ST STE 206
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1768
Country	:	US
Telephone Number	:	971-357-2061
Fax Number	:	971-357-2561

Provider Business Practice Location Address
First Line	:	2705 E BURNSIDE ST STE 206
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-1768
Country	:	US
Telephone Number	:	971-357-2061
Fax Number	:	971-357-2561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	01/12/2026

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