MEDICARE: AMY PATRICIA KYSER INTERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1053177709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY PATRICIA KYSER INTERN

Provider Business Mailing Address
First Line	:	19289 GENTRY HIGHLANDS LN
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-7578
Country	:	US
Telephone Number	:	503-501-8928
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 SW GREENBURG RD STE 235
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-5473
Country	:	US
Telephone Number	:	503-410-3078
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2024
Last Update Date	:	02/21/2024

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