Individual
KIMBERLY BRENNAN TYLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(506) 494-9000
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(506) 494-9000
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
200540047RN
OR
363LA2200X
Adult Health Nurse Practitioner
200550020NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023050
—
OR
Enumeration date
08/03/2006
Last updated
02/03/2010
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