MEDICARE: KIVALANI MCMURRIN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10053117	OR
2	163W00000X	Registered Nurse	281411	TN
3	163W00000X	Registered Nurse	10053117	OR
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	40136	TN

General Provider Information

NPI Number	:	1326859299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIVALANI MCMURRIN

Provider Business Mailing Address
First Line	:	5311 N VANCOUVER AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-2731
Country	:	US
Telephone Number	:	801-609-4737
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 N VANCOUVER AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-2731
Country	:	US
Telephone Number	:	503-239-8181
Fax Number	:	503-548-4013

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

Provider Enumeration Date	:	01/18/2025
Last Update Date	:	04/16/2026

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Directions to “ KIVALANI MCMURRIN ” Practice Location

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