Provider Demographics
NPI:1114138427
Name:MAY, BARBARA A (PMHNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:MAY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:PINKAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:160 N TOMAHAWK ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-7916
Mailing Address - Country:US
Mailing Address - Phone:503-247-8126
Mailing Address - Fax:
Practice Address - Street 1:1015 NW 22ND AVE
Practice Address - Street 2:NORTHRUP #34
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3025
Practice Address - Country:US
Practice Address - Phone:503-413-8096
Practice Address - Fax:503-413-4846
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR086006838N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000304Medicaid
WA9643354Medicaid
OR117500Medicare ID - Type Unspecified
OR133075Medicare ID - Type Unspecified
WA9643354Medicaid
OR000304Medicaid