Provider Demographics
NPI:1376074427
Name:KING COLE, ANGELLA MICHELLE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELLA
Middle Name:MICHELLE
Last Name:KING COLE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10260 SW GREENBURG RD STE 400-569
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5500
Mailing Address - Country:US
Mailing Address - Phone:503-410-3069
Mailing Address - Fax:503-214-8455
Practice Address - Street 1:10260 SW GREENBURG RD STE 400-569
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5500
Practice Address - Country:US
Practice Address - Phone:503-410-3069
Practice Address - Fax:503-214-8455
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201607321RN163W00000X
OR201806260N-PP363LP0808X
OR201806260NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse