Provider Demographics
NPI:1598895013
Name:REKART, CORINNE A (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:A
Last Name:REKART
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:CORRI
Other - Middle Name:A
Other - Last Name:REKART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:4784 N LOMBARD SR
Mailing Address - Street 2:SUITE B #1077
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203
Mailing Address - Country:US
Mailing Address - Phone:229-210-7379
Mailing Address - Fax:503-343-6185
Practice Address - Street 1:30 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-779-6174
Practice Address - Fax:503-232-3854
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61125788363LP0808X
OR201341636RN163WP0809X
OR202010541NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult