Provider Demographics
NPI:1417698804
Name:STEFFEN, KAITLYN (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:STEFFEN
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 S MACADAM AVE STE 258
Mailing Address - Street 2:#1015
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:971-715-0754
Mailing Address - Fax:971-206-9686
Practice Address - Street 1:6901 SE LAKE RD STE 27
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2195
Practice Address - Country:US
Practice Address - Phone:971-715-0754
Practice Address - Fax:971-206-9686
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10019648363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10019648OtherANCC
TX1074489OtherCERTIFIED NURSE PRACTITIONER
TX931890OtherRN