Provider Demographics
NPI:1114231016
Name:KEIRNS, TERESA BURNELLE (RN, CNM)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:BURNELLE
Last Name:KEIRNS
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 SE ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-3121
Mailing Address - Country:US
Mailing Address - Phone:401-225-6167
Mailing Address - Fax:
Practice Address - Street 1:3727 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1112
Practice Address - Country:US
Practice Address - Phone:888-875-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1904367A00000X
CA730310163W00000X
OR201601564NP-PP367A00000X
WAAP60670307176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife