Individual
MR. KYLE EDWARD ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
12655 SW CENTER ST STE 150, BEAVERTON, OR 97005-1864
(503) 832-0945
Mailing address
1410 NE 106TH AVE, PORTLAND, OR 97220-3934
(210) 289-5953
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202007455NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP143637
TX
Other
Enumeration date
10/23/2019
Last updated
12/16/2025
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