Provider Demographics
NPI:1902835838
Name:KERWAN, KATHLEEN PATRICIA (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:KERWAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:PATRICIA
Other - Last Name:MAYNEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11145 SW MEADOWBROOK DR APT 5
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3349
Mailing Address - Country:US
Mailing Address - Phone:503-780-3294
Mailing Address - Fax:
Practice Address - Street 1:7150 SW HAMPTON ST STE 200
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8378
Practice Address - Country:US
Practice Address - Phone:503-482-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950047NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily