Active NPI
Korie Kathlyne Mullenberg, ARNP-BC
- Psychiatric/Mental Health Nurse Practitioner
- Portland, OR
National Provider Identifier
1568239341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 10019170
- Practice address
- 13908 SE Stark St Ste a
Portland, OR 97233-2161 - Phone
- (503) 255-2343
- NPI assigned
- Dec 11, 2023
- Sex
- Female
- Sole proprietor
- No
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 | 10019170 | OR | Primary |
Addresses
Primary practice location
13908 SE Stark St Ste a
Portland, OR 97233-2161
Mailing address
13908 SE Stark St Ste a
Portland, OR 97233-2161
Phone (503) 255-2343
Other names 1
- Korie Kathlyne Parks
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 29, 2024 through Jan 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10019170 | 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": "1702252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702252800000",
"number": "1568239341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13908 SE STARK ST STE A",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972332161",
"telephone_number": "503-255-2343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13908 SE STARK ST STE A",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972332161",
"telephone_number": "503-255-2343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLENBERG",
"first_name": "KORIE",
"middle_name": "KATHLYNE",
"credential": "ARNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-11",
"last_updated": "2023-12-11",
"certification_date": "2023-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "OR",
"license": "10019170",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KORIE",
"last_name": "PARKS",
"middle_name": "KATHLYNE",
"code": "1",
"type": "Former Name"
}
]
}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 Dec 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.