MEDICARE: KELLY SAWYER 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10012845	OR

General Provider Information

NPI Number	:	1770366502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY SAWYER PMHNP

Provider Business Mailing Address
First Line	:	757 W MARINE DR STE 104
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-5848
Country	:	US
Telephone Number	:	503-366-4850
Fax Number	:	888-971-4017

Provider Business Practice Location Address
First Line	:	757 W MARINE DR STE 104
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-5848
Country	:	US
Telephone Number	:	503-366-4850
Fax Number	:	888-971-4017

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

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	06/10/2026

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Directions to “ KELLY SAWYER PMHNP” Practice Location

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