Healthcare Provider Details

I. General information

NPI: 1215891932
Provider Name (Legal Business Name): CORTNEY HOLMES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17814 NE DAVIS ST
PORTLAND OR
97230-6621
US

IV. Provider business mailing address

17814 NE DAVIS ST
PORTLAND OR
97230-6621
US

V. Phone/Fax

Practice location:
  • Phone: 206-617-4834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202105631RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: