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General NPI Number Information
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NPI Number | 1306399027
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Entity Type | Individual
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Provider Name | CHARLES CHRISTIAN KOHNKEN APRN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 535 SE WASHINGTON ST
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City | HILLSBORO
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State | OR
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Zip | 97123-4142
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Country | US
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Telephone | 503-755-6703
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Fax | 503-755-6704
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Provider Business Mailing Address
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Address Line | 833 CALLISTA CAY LOOP
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-0002
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Country | US
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Telephone | 727-810-1556
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN 9331526
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9331526
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP11291
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10035421
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License Number State | OR
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