Provider Demographics
NPI:1558995217
Name:NORVILLE, MYKAH CONANT (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MYKAH
Middle Name:CONANT
Last Name:NORVILLE
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10690 NE CORNELL RD STE 315
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9224
Mailing Address - Country:US
Mailing Address - Phone:503-352-0468
Mailing Address - Fax:503-352-1024
Practice Address - Street 1:10690 NE CORNELL RD STE 315
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9224
Practice Address - Country:US
Practice Address - Phone:503-352-0468
Practice Address - Fax:503-352-1024
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201242529RN163WP0807X
WARN60312665163WP0807X
WAAP61364034363LP0808X
OR10003518363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent