Healthcare Provider Details

I. General information

NPI: 1336831031
Provider Name (Legal Business Name): RAMATOU KARGBO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 SW COURT PL
PENDLETON OR
97801-1896
US

IV. Provider business mailing address

2203 SW COURT PL
PENDLETON OR
97801-1896
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-5761
  • Fax:
Mailing address:
  • Phone: 505-440-5761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10015189
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024187112
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: