Active NPI
Gretchen Randolph, PH.D, PMHNP
- Psychiatric/Mental Health Nurse Practitioner
- Tigard, OR
National Provider Identifier
1184876898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- S80045119NG
- Practice address
- 13635 SW 115TH Ave
Tigard, OR 97223-2862 - Phone
- (503) 968-1155
- NPI assigned
- Oct 14, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | S80045119NG | OR | Primary |
Addresses
Primary practice location
13635 SW 115TH Ave
Tigard, OR 97223-2862
Mailing address
13635 SW 115TH Ave
Tigard, OR 97223-2862
Phone (503) 968-1155
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S80045119NG | OR | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223942400000",
"number": "1184876898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13635 SW 115TH AVE",
"city": "TIGARD",
"state": "OR",
"postal_code": "972232862",
"telephone_number": "503-968-1155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13635 SW 115TH AVE",
"city": "TIGARD",
"state": "OR",
"postal_code": "972232862",
"telephone_number": "503-968-1155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "GRETCHEN",
"name_prefix": "Dr.",
"credential": "PH.D, PMHNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-14",
"last_updated": "2008-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "OR",
"license": "S80045119NG",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.