Provider Demographics
NPI:1295332567
Name:LIECHTY, KARA LYNN (CNS-PP)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:LYNN
Last Name:LIECHTY
Suffix:
Gender:F
Credentials:CNS-PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 NW 22ND AVE STE 345
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2978
Mailing Address - Country:US
Mailing Address - Phone:503-413-7513
Mailing Address - Fax:
Practice Address - Street 1:1130 NW 22ND AVE STE 345
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2978
Practice Address - Country:US
Practice Address - Phone:503-413-7513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201609037RN163W00000X
OR202004895CNS-PP364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse