Provider Demographics
NPI:1982051959
Name:MORALES, NICHOLAS DAVID (PMHNP)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DAVID
Last Name:MORALES
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10117SE SUNNYSIDE RD.
Mailing Address - Street 2:F1217
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-740-1971
Mailing Address - Fax:503-771-2436
Practice Address - Street 1:9123 SE SAINT HELENS ST STE 100F
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6800
Practice Address - Country:US
Practice Address - Phone:503-740-1971
Practice Address - Fax:503-771-2436
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201603282NP-PP363LG0600X
OR1982051959363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500707281Medicaid