Individual
MS. SUPRIYA S KAUSHIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4400 NE HALSEY ST BLDG 2, PORTLAND, OR 97213-1545
(503) 215-0750
Mailing address
4400 NE HALSEY ST BLDG 2, PORTLAND, OR 97213-1545
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
914238
OR
363A00000X
Physician Assistant
Primary
PA152640
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA152640
OREGON PA LICENSE
OR
Enumeration date
12/21/2010
Last updated
11/02/2021
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