Provider Demographics
NPI:1245014398
Name:HUTCHESON, AVERY ROSE KADAS
Entity type:Individual
Prefix:MRS
First Name:AVERY
Middle Name:ROSE KADAS
Last Name:HUTCHESON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 SE KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7822
Mailing Address - Country:US
Mailing Address - Phone:541-231-6478
Mailing Address - Fax:
Practice Address - Street 1:8333 SE 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7101
Practice Address - Country:US
Practice Address - Phone:503-494-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201704785RN163WP0200X
OR10014456363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics