Healthcare Provider Details

I. General information

NPI: 1245014398
Provider Name (Legal Business Name): MRS. AVERY ROSE KADAS HUTCHESON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 SE 13TH AVE
PORTLAND OR
97202-7101
US

IV. Provider business mailing address

4021 SE KNAPP ST
PORTLAND OR
97202-7822
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-9300
  • Fax:
Mailing address:
  • Phone: 541-231-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number201704785RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number10014456
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: