Provider Demographics
NPI:1720255854
Name:NIBBLETT, KAREN E (PMHNP, CNS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:NIBBLETT
Suffix:
Gender:F
Credentials:PMHNP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13007 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2545
Mailing Address - Country:US
Mailing Address - Phone:503-215-5600
Mailing Address - Fax:503-215-7864
Practice Address - Street 1:13007 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2545
Practice Address - Country:US
Practice Address - Phone:503-215-5600
Practice Address - Fax:503-215-7864
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450084 NP363LP0808X
OR200470021CNS364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology