Provider Demographics
NPI:1649231259
Name:KHOURY, ERIN N (PA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:N
Last Name:KHOURY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:975 SE SANDY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1308
Mailing Address - Country:US
Mailing Address - Phone:503-236-0775
Mailing Address - Fax:503-236-0786
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:SUITE 5020
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3975
Practice Address - Country:US
Practice Address - Phone:503-371-4044
Practice Address - Fax:503-371-4356
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-06-24
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Provider Licenses
StateLicense IDTaxonomies
ORPA01423363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1649231259Medicaid
OR500614413Medicaid
WA1649231259Medicaid
ORP56032Medicare UPIN