Provider Demographics
NPI:1669136131
Name:GIDEON, SKYLER AUGUST (FNP-C)
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:AUGUST
Last Name:GIDEON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRIT/BRITTANY
Other - Middle Name:ANN
Other - Last Name:GEDEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:721 NW 9TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3519
Mailing Address - Country:US
Mailing Address - Phone:503-525-0090
Mailing Address - Fax:971-244-0219
Practice Address - Street 1:721 NW 9TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3519
Practice Address - Country:US
Practice Address - Phone:503-525-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202112377NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily