Provider Demographics
NPI:1558644955
Name:BARKER-ANDERSON, ELLEN CARLA (APNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CARLA
Last Name:BARKER-ANDERSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:CARLA
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:833 SW 11TH AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2132
Mailing Address - Country:US
Mailing Address - Phone:503-442-6105
Mailing Address - Fax:503-234-7166
Practice Address - Street 1:833 SW 11TH AVE STE 245
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2132
Practice Address - Country:US
Practice Address - Phone:503-442-6105
Practice Address - Fax:503-234-7166
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201601411363LP0808X
CA21181363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500713858Medicaid
OR201601411OtherSTATE LICENSE - NURSE PRACTITIONER