Active NPI
Charisa Ann King, APRN-NP, PMHNP-BC
- Psychiatric/Mental Health Nurse Practitioner
- Portland, OR
National Provider Identifier
1366228264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 100152
- Practice address
- 6647 SE Milwaukie Ave Ste B210
Portland, OR 97202-5661 - Phone
- (971) 258-2120
- NPI assigned
- Sep 6, 2023
- 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 | 100152 | OR | Primary |
Addresses
Primary practice location
6647 SE Milwaukie Ave Ste B210
Portland, OR 97202-5661
Mailing address
17617 Sydni CT
Lake Oswego, OR 97035-5588
Phone (435) 850-9535
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100152 | 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": "1693958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697587200000",
"number": "1366228264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17617 SYDNI CT",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970355588",
"telephone_number": "435-850-9535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6647 SE MILWAUKIE AVE STE B210",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972025661",
"telephone_number": "971-258-2120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "CHARISA",
"middle_name": "ANN",
"credential": "APRN-NP, PMHNP-BC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-06",
"last_updated": "2023-10-18",
"certification_date": "2023-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "OR",
"license": "100152",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.