Healthcare Provider Details

I. General information

NPI: 1598117434
Provider Name (Legal Business Name): SOMMER TIFFANY KORTH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2016
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18765 SW BOONES FERRY RD STE 100
TUALATIN OR
97062-8607
US

IV. Provider business mailing address

18765 SW BOONES FERRY RD STE 100
TUALATIN OR
97062-8607
US

V. Phone/Fax

Practice location:
  • Phone: 503-612-1000
  • Fax: 503-612-1090
Mailing address:
  • Phone: 503-612-1000
  • Fax: 503-612-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG165850
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10047729
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5928365-4405
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number114138
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: