Healthcare Provider Details

I. General information

NPI: 1427065234
Provider Name (Legal Business Name): SHERYL ANN HEDGES NP,PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12710 SE DIVISION ST.
PORTLAND OR
97236
US

IV. Provider business mailing address

421 SW OAK ST. 210
PORTLAND OR
97204
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-3601
  • Fax: 503-988-4098
Mailing address:
  • Phone: 503-988-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number090007034N6
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number090007034N6
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number090007034N6
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: