MEDICARE: MS. PAMELA ANN MOORE PMHNP

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	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	200740981RN	OR
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	200950074NP	OR

General Provider Information

NPI Number	:	1710189360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA ANN MOORE PMHNP

Provider Business Mailing Address
First Line	:	9600 SW OAK ST
Second Line	:	SUITE 525
City	:	TIGARD
State	:	OR
Zip	:	97223-6583
Country	:	US
Telephone Number	:	503-960-3334
Fax Number	:	503-935-5884

Provider Business Practice Location Address
First Line	:	9600 SW OAK ST
Second Line	:	SUITE 525
City	:	TIGARD
State	:	OR
Zip	:	97223-6583
Country	:	US
Telephone Number	:	503-960-3334
Fax Number	:	503-935-5884

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	01/28/2014

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