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General NPI Number Information
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NPI Number | 1366228264
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Entity Type | Individual
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Provider Name | CHARISA ANN KING APRN-NP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 6647 SE MILWAUKIE AVE STE B210
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City | PORTLAND
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State | OR
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Zip | 97202-5661
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Country | US
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Telephone | 971-258-2120
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Fax |
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Provider Business Mailing Address
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Address Line | 17617 SYDNI CT
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-5588
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Country | US
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Telephone | 435-850-9535
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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 | 100152
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License Number State | OR
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