Provider Demographics
NPI:1477885218
Name:NOVOTNY, JAMES ALEXANDER (FNP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALEXANDER
Last Name:NOVOTNY
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:1130 NW 22ND AVE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2900
Mailing Address - Country:US
Mailing Address - Phone:503-229-7976
Mailing Address - Fax:503-274-4867
Practice Address - Street 1:12550 SE 93RD AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9786
Practice Address - Country:US
Practice Address - Phone:503-654-1153
Practice Address - Fax:503-654-7693
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR201150071NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily