Provider Demographics
NPI:1598316572
Name:RACHKO, TREVOR SCOTT (PMHNP, MSN)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:SCOTT
Last Name:RACHKO
Suffix:
Gender:M
Credentials:PMHNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44882 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-9293
Mailing Address - Country:US
Mailing Address - Phone:541-429-0550
Mailing Address - Fax:541-276-3093
Practice Address - Street 1:44882 MISSION RD
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9293
Practice Address - Country:US
Practice Address - Phone:541-429-0550
Practice Address - Fax:541-276-3093
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-22
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201909432NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty