Individual
BETHANY KINGSBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-NP
Contact information
Practice address
5050 NE HOYT ST STE 610, PORTLAND, OR 97213-2985
(503) 467-4761
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0121579
OK
163WR0006X
Registered Nurse First Assistant
R0121579
OK
363L00000X
Nurse Practitioner
10036936
OR
363L00000X
Nurse Practitioner
200647
OK
363LA2100X
Acute Care Nurse Practitioner
200647
OK
363LG0600X
Gerontology Nurse Practitioner
Primary
10036936
OR
Other
Enumeration date
04/01/2019
Last updated
03/04/2025
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