Healthcare Provider Details

I. General information

NPI: 1639302508
Provider Name (Legal Business Name): HEATHER M KITTERMAN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 SW GREENBURG RD
TIGARD OR
97223-6453
US

IV. Provider business mailing address

1104 WESTERN AVE
SILVERTON OR
97381-1018
US

V. Phone/Fax

Practice location:
  • Phone: 503-597-1215
  • Fax:
Mailing address:
  • Phone: 503-989-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200950125NP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201400012NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: