Provider Demographics
NPI:1386812329
Name:FOUST, MIRANDA L (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:FOUST
Suffix:
Gender:F
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 1:11211 SE 82ND AVE STE O
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7641
Mailing Address - Country:US
Mailing Address - Phone:503-655-8585
Mailing Address - Fax:503-722-6545
Practice Address - Street 1:11211 SE 82ND AVE STE O
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7641
Practice Address - Country:US
Practice Address - Phone:503-655-8585
Practice Address - Fax:503-722-6545
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201392158NP-PP163WP0808X
OR201143233RN163WP0808X
OR201392158NP363LC1500X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health