Healthcare Provider Details

I. General information

NPI: 1922631787
Provider Name (Legal Business Name): KARA SUMP RN, QMHP-RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NE HIGHWAY 99W STE K
MCMINNVILLE OR
97128-2757
US

IV. Provider business mailing address

650 NE 2ND ST UNIT 133
MCMINNVILLE OR
97128-4762
US

V. Phone/Fax

Practice location:
  • Phone: 503-714-6306
  • Fax: 503-472-4511
Mailing address:
  • Phone: 503-714-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number200942164RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number200942164RN
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number200942164RN
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number200942164RN
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number200942164RN
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number200942164RN
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number200942164RN
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number200942164RN
License Number StateOR
# 9
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number200942164RN
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: