Provider Demographics
NPI:1659194785
Name:HERNANDEZ, KIEU (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:KIEU
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 S IVY ST
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-7359
Mailing Address - Country:US
Mailing Address - Phone:832-589-2530
Mailing Address - Fax:
Practice Address - Street 1:1200 NE 48TH AVE STE 1100
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5062
Practice Address - Country:US
Practice Address - Phone:503-494-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10034954363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner