Provider Demographics
NPI:1639291057
Name:ALEXANDER, MARY KAY (RN, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY KAY
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:MARYKAY
Other - Middle Name:
Other - Last Name:HJORTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN PMHNP
Mailing Address - Street 1:7455 SW BEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8610
Mailing Address - Country:US
Mailing Address - Phone:503-624-2600
Mailing Address - Fax:503-624-7752
Practice Address - Street 1:7455 SW BEVELAND RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8610
Practice Address - Country:US
Practice Address - Phone:503-624-2600
Practice Address - Fax:503-624-7752
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR082010334N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health