MRS. STACY L. HARTLINE


Address: 912 Ne Kelly Ave, Suite 200, Gresham, OR 97030
Phone: 5032584600

MRS. STACY L. HARTLINE (NPI# 1568661528) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1568661528
Entity Type Individual
Full Name MRS. STACY L. HARTLINE
Credential APRN, PMHNP
Practice Address 912 Ne Kelly Ave, Suite 200
Gresham
OR 97030
Mailing Address 912 Ne Kelly Ave. Suite 200
Gresham
OR 97030
Practice Telephone 5032584600
Practice Fax Number 5036672580
Mailing Telephone 5032584600
Mailing Fax Number 5034132649
Enumeration Date 2007-07-11
Last Update Date 2014-11-05
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
200750069NP OR Physician Assistants & Advanced Practice Nursing Providers
Y 163WP0807X Registered Nurse
Specialization: Psych/Mental Health, Child & Adolescent
200542250RN OR Nursing Service Providers
N 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
20075006NPTMHNP- OR Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 912 NE KELLY AVE, SUITE 200
City GRESHAM
State OR
Zip Code 97030

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1861940454 Jessica Morrow Massage Therapist 1748 Nw Fairview Dr., Gresham, OR 97030 2016-09-13
1033665898 Bonita Baxter Counselor 400 Ne 7th Street, Gresham, OR 97030 2016-08-31
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1932568912 Atchison Dialysis, LLC Clinic/Center 878 Nw Burnside Rd, Gresham, OR 97030 2016-02-18
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Taxonomy Information

Taxonomy Code 163WP0807X
Grouping Nursing Service Providers
Classification Registered Nurse
Specialization Psych/Mental Health, Child & Adolescent

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1164895173 Jessica L Newgard Registered Nurse 9135 Sw Barnes Rd Ste 761, Portland, OR 97225-6777 2015-11-12
1295128650 Marla Castello Registered Nurse 2828 Sw Kelly Ave Ste B, Portland, OR 97201-4809 2015-03-10
1972928034 Jennifer Joe-anne Marks Registered Nurse 312 Oak St. Ste #205, Central Point, OR 97502 2014-02-26
1376883488 Jennifer Dyann Tucker Registered Nurse 2650 Nw Princess St, Corvallis, OR 97330-3219 2013-02-26
1124378526 Melissa Hess Registered Nurse 3415 Se Powell Blvd # 97202, Portland, OR 97202-3371 2012-09-12
1396051637 Justin Nicholas Bethoney Registered Nurse 151 Sw Shevlin Hixon Dr Ste 102, Bend, OR 97702-3232 2010-08-24
1770705527 Carol B. Mason Registered Nurse 722 Ne 162nd Avenue, Portland, OR 97230 2007-05-02
1346325883 Cynthia Kathleen Rutto Registered Nurse 2929 Sw Multnomah Blvd Ste 102, Portland, OR 97219-4070 2006-10-25
1447862198 Kiana Wood Registered Nurse 3415 Se Powell Blvd, Portland, OR 97202-3371 2020-08-22
1134737521 Tia Nadler Registered Nurse 3415 Se Powell Blvd, Portland, OR 97202-3371 2020-07-21
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Competitor

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City GRESHAM
Zip Code 97030

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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