=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063697555
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATRINA L MCALEXANDER NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2008
-----------------------------------------------------
Last Update Date | 12/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 SW STARK ST 8TH FLOOR
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97204-2302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-988-3674
-----------------------------------------------------
Fax | 503-988-5183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 421 SW OAK ST 210
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97204-1817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-988-3674
-----------------------------------------------------
Fax | 503-988-4098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 200750096NP PMHNP-PP
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------