Healthcare Provider Details

I. General information

NPI: 1770366502
Provider Name (Legal Business Name): KELLY SAWYER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 W MARINE DR STE 104
ASTORIA OR
97103-5848
US

IV. Provider business mailing address

757 W MARINE DR STE 104
ASTORIA OR
97103-5848
US

V. Phone/Fax

Practice location:
  • Phone: 503-366-4850
  • Fax: 888-971-4017
Mailing address:
  • Phone: 503-366-4850
  • Fax: 888-971-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10012845
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: