Provider Demographics
NPI:1003425489
Name:RICHARDS, A'LISSA (PMHNP)
Entity Type:Individual
Prefix:
First Name:A'LISSA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:12121 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3737
Mailing Address - Country:US
Mailing Address - Phone:971-361-7700
Mailing Address - Fax:
Practice Address - Street 1:12121 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3737
Practice Address - Country:US
Practice Address - Phone:971-361-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202006706NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health