MEDICARE: DR. PIERRE-CEDRIC BERNARD CROUCH PHD,ANP-BC,PMHNP-BC

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	163W00000X	Registered Nurse	202002074RN	OR
2	363L00000X	Nurse Practitioner	17368	CA
3	363LA2200X	Adult Health Nurse Practitioner	17368	CA
4	363LA2200X	Adult Health Nurse Practitioner	202004463NP-PP	OR
5	163W00000X	Registered Nurse	581556	CA
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	202004463NP-PP	OR
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	17368	CA

General Provider Information

NPI Number	:	1194869313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PIERRE-CEDRIC BERNARD CROUCH PHD,ANP-BC,PMHNP-BC

Provider Business Mailing Address
First Line	:	2119 NE HALSEY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 NE HALSEY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1522
Country	:	US
Telephone Number	:	503-427-8006
Fax Number	:	503-741-8079

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	04/27/2026

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