Provider Demographics
NPI:1982137501
Name:HUYNH, PATRICK N (FNP-BC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:N
Last Name:HUYNH
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14795 SW MURRAY SCHOLLS DR STE 121
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9713
Mailing Address - Country:US
Mailing Address - Phone:503-747-4936
Mailing Address - Fax:
Practice Address - Street 1:9300 W OVERLAND RD STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-8263
Practice Address - Country:US
Practice Address - Phone:208-268-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV829203363L00000X
WAAP61050684363L00000X
COAPN.00995646-NP363L00000X
OHAPRN.CNP.0027848363L00000X
OR201702486NP-PP363L00000X, 363LF0000X
ID65936363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500725686Medicaid