Provider Demographics
NPI:1346765880
Name:SHORE, CARY (ARNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:
Last Name:SHORE
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 NW YEON AVE SUITE 606
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-664-9451
Mailing Address - Fax:
Practice Address - Street 1:555 SE MARTIN LUTHER KING JR BLVD STE 105
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2120
Practice Address - Country:US
Practice Address - Phone:503-664-9451
Practice Address - Fax:503-386-3230
Is Sole Proprietor?:No
Enumeration Date:2017-08-06
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60468151163W00000X
OR201902708RN163W00000X
WA2017010049363LP0808X
OR201903897NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse