Healthcare Provider Details

I. General information

NPI: 1073391553
Provider Name (Legal Business Name): JAMES CHRISTOPHER PERDUE CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 NE HALSEY ST
PORTLAND OR
97232-1522
US

IV. Provider business mailing address

2119 NE HALSEY ST
PORTLAND OR
97232-1522
US

V. Phone/Fax

Practice location:
  • Phone: 503-975-9398
  • Fax: 503-221-8320
Mailing address:
  • Phone: 503-975-9398
  • Fax: 503-221-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10015019
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-153747
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: