MS. MOLLIE KATHLEEN PENCE


Address: 2415 43rd Ave, Suite 100, Cascadia Behavioral Healthcare Urgent Walkin Clinic, Portland, OR 97206
Phone: 5032380705

MS. MOLLIE KATHLEEN PENCE (NPI# 1639625205) 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) 1639625205
Entity Type Individual
Full Name MS. MOLLIE KATHLEEN PENCE
Other Name MRS. MOLLIE KATHLEEN GARDNER
Credential PMHNP, RN
Practice Address 2415 43rd Ave, Suite 100
Cascadia Behavioral Healthcare Urgent Walkin Clinic
Portland
OR 97206
Mailing Address P.o. Box 86444
Portland
OR 97286
Practice Telephone 5032380705
Practice Fax Number 5032367166
Mailing Telephone 5037933212
Enumeration Date 2016-09-01
Last Update Date 2019-10-09
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 163W00000X Registered Nurse 201800505RN OR Nursing Service Providers
N 163W00000X Registered Nurse 350691 OH Nursing Service Providers
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
201801169NP-PP OR Physician Assistants & Advanced Practice Nursing Providers
N 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
01801169NP-PP OR Physician Assistants & Advanced Practice Nursing Providers
N 364SP0808X Clinical Nurse Specialist
Specialization: Psych/Mental Health
APRN.CNP.019504 OH Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
OH DEA XG3947833 01
OH DEA MG394-7833 01

Office Location

Street Address 2415 43RD AVE, SUITE 100
CASCADIA BEHAVIORAL HEALTHCARE URGENT WALKIN CLINIC
City PORTLAND
State OR
Zip Code 97206

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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

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1245719541 Scott J Whited Nurse Practitioner 216 Vaughan St., Mcgeachy Hall, Portland, ME 04101 2018-08-08
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Competitor

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City PORTLAND
Zip Code 97206

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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