Provider Demographics
NPI:1912675786
Name:PETREDIS, KARA LYNN (PMHNP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LYNN
Last Name:PETREDIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 WILLAMETTE STREET, SUITE 301, #140
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4593
Mailing Address - Country:US
Mailing Address - Phone:541-255-1411
Mailing Address - Fax:541-255-1412
Practice Address - Street 1:1551 OAK ST STE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4023
Practice Address - Country:US
Practice Address - Phone:541-255-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-05
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR202204007NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health