Healthcare Provider Details

I. General information

NPI: 1821715285
Provider Name (Legal Business Name): TIMOTHY SCOTT HAMN NP, FNP-BC, CWS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TIMOTHY SCOTT HAMN NP, FNPBC, FNPC, CWS

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E CLARENDON ST
GLADSTONE OR
97027-2431
US

IV. Provider business mailing address

305 E CLARENDON ST
GLADSTONE OR
97027-2431
US

V. Phone/Fax

Practice location:
  • Phone: 509-655-9562
  • Fax: 321-425-8535
Mailing address:
  • Phone: 509-655-9562
  • Fax: 321-425-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10004408
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10004408
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61369075
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: