Healthcare Provider Details

I. General information

NPI: 1639028608
Provider Name (Legal Business Name): TRAVIS R OHGE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 NE HIGHWAY 20
CORVALLIS OR
97330-9695
US

IV. Provider business mailing address

3415 SE POWELL BLVD
PORTLAND OR
97202-3371
US

V. Phone/Fax

Practice location:
  • Phone: 541-758-5900
  • Fax:
Mailing address:
  • Phone: 503-234-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10062839
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: