Healthcare Provider Details

I. General information

NPI: 1831462407
Provider Name (Legal Business Name): BRIANA KJORNES PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANA RIVERA PA-S

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD GH219
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD GH219
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-3633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA165908
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA165908
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: