Healthcare Provider Details

I. General information

NPI: 1598895013
Provider Name (Legal Business Name): CORINNE A REKART PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORRI A REKART RN

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NE MARTIN LUTHER KING JR BLVD
PORTLAND OR
97232
US

IV. Provider business mailing address

2705 E BURNSIDE ST STE 206
PORTLAND OR
97214-1768
US

V. Phone/Fax

Practice location:
  • Phone: 503-779-6174
  • Fax: 503-232-3854
Mailing address:
  • Phone: 971-357-2061
  • Fax: 971-357-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61125788
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number201341636RN
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202010541NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: