Provider Demographics
NPI:1598117434
Name:KORTH, SOMMER TIFFANY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SOMMER
Middle Name:TIFFANY
Last Name:KORTH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18765 SW BOONES FERRY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8607
Mailing Address - Country:US
Mailing Address - Phone:503-612-1000
Mailing Address - Fax:503-612-1090
Practice Address - Street 1:18765 SW BOONES FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8607
Practice Address - Country:US
Practice Address - Phone:503-612-1000
Practice Address - Fax:503-612-1090
Is Sole Proprietor?:No
Enumeration Date:2016-07-03
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG165850363LP0808X
OR10047729363LP0808X
UT5928365-4405363L00000X
NE114138363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE114138OtherSTATE OF NEBRASKA DEPT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH
IAA165752OtherIOWA BOARD OF NURSING
SDCP002103OtherSOUTH DAKOTA BOARD OF NURSING
IAG165850OtherIOWA BOARD OF NURSING