Healthcare Provider Details

I. General information

NPI: 1902835838
Provider Name (Legal Business Name): KATHLEEN PATRICIA KERWAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN PATRICIA MAYNEZ

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 SW HAMPTON ST STE 200
TIGARD OR
97223-8378
US

IV. Provider business mailing address

11145 SW MEADOWBROOK DR APT 5
TIGARD OR
97224-3349
US

V. Phone/Fax

Practice location:
  • Phone: 503-482-4600
  • Fax:
Mailing address:
  • Phone: 503-780-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200950047NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: