Provider Demographics
NPI:1073245544
Name:JOHNSON, TAMARA KWON (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:KWON
Last Name:JOHNSON
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 SW CANYON LN STE 236
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-3452
Mailing Address - Country:US
Mailing Address - Phone:971-500-5551
Mailing Address - Fax:971-529-1747
Practice Address - Street 1:8835 SW CANYON LN STE 236
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-3452
Practice Address - Country:US
Practice Address - Phone:971-500-5551
Practice Address - Fax:971-529-1747
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61327985363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health