Provider Demographics
NPI:1447336037
Name:PHIFER, KERRY E M (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:E M
Last Name:PHIFER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:MCGUIRL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:10121 SE SUNNYSIDE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5713
Mailing Address - Country:US
Mailing Address - Phone:971-303-3107
Mailing Address - Fax:503-786-9919
Practice Address - Street 1:6400 SE LAKE RD STE 325
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-2185
Practice Address - Country:US
Practice Address - Phone:503-786-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650118NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid
OR0000WDBCHMedicare ID - Type UnspecifiedGROUP #