Individual
EMNET KABA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12822 SE OTT ST, CLACKAMAS, OR 97015-8637
(202) 710-7011
Mailing address
12822 SE OTT ST, CLACKAMAS, OR 97015-8637
(202) 710-7011
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10052714
OR
Other
Enumeration date
11/04/2025
Last updated
11/04/2025
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