Provider Demographics
NPI:1710189360
Name:MOORE, PAMELA ANN (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9600 SW OAK ST
Mailing Address - Street 2:SUITE 525
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6583
Mailing Address - Country:US
Mailing Address - Phone:503-960-3334
Mailing Address - Fax:503-935-5884
Practice Address - Street 1:9600 SW OAK ST
Practice Address - Street 2:SUITE 525
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6583
Practice Address - Country:US
Practice Address - Phone:503-960-3334
Practice Address - Fax:503-935-5884
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200740981RN163WP0807X
OR200950074NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent