Healthcare Provider Details

I. General information

NPI: 1710189360
Provider Name (Legal Business Name): PAMELA ANN MOORE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 SW OAK ST SUITE 525
TIGARD OR
97223-6583
US

IV. Provider business mailing address

9600 SW OAK ST SUITE 525
TIGARD OR
97223-6583
US

V. Phone/Fax

Practice location:
  • Phone: 503-960-3334
  • Fax: 503-935-5884
Mailing address:
  • Phone: 503-960-3334
  • Fax: 503-935-5884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number200740981RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200950074NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: