Provider Demographics
NPI:1447364054
Name:SHOMLER, KARYN CARPENTER (RN, NP)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:CARPENTER
Last Name:SHOMLER
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:KARYN
Other - Middle Name:LEE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP
Mailing Address - Street 1:867 W LOOKOUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-7439
Mailing Address - Country:US
Mailing Address - Phone:360-833-3160
Mailing Address - Fax:
Practice Address - Street 1:5100 SW MACADAM AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6102
Practice Address - Country:US
Practice Address - Phone:971-202-5500
Practice Address - Fax:971-202-5555
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13292363LA2200X
OR201606020NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP95935Medicare UPIN