Healthcare Provider Details

I. General information

NPI: 1538537121
Provider Name (Legal Business Name): KHIA GILBERT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KHIA N COLLET

II. Dates (important events)

Enumeration Date: 09/13/2015
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14415 SE 119TH AVE
CLACKAMAS OR
97015-7217
US

IV. Provider business mailing address

PO BOX 3390
PORTLAND OR
97208-3390
US

V. Phone/Fax

Practice location:
  • Phone: 503-425-9773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number201502102RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number201502102RN
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: