Provider Demographics
NPI:1821002908
Name:PETERS, KAREN MAY (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MAY
Last Name:PETERS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 SE EXETER DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-9009
Mailing Address - Country:US
Mailing Address - Phone:503-238-3827
Mailing Address - Fax:503-233-4108
Practice Address - Street 1:1839 SE EXETER DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-9009
Practice Address - Country:US
Practice Address - Phone:503-238-3827
Practice Address - Fax:503-233-4108
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR075035036N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR114434Medicaid
ORS63218Medicare UPIN
OR111784Medicare ID - Type Unspecified