TARA PEMBERTON (NPI# 1275803462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275803462 |
| Entity Type | Individual |
| Full Name | TARA PEMBERTON |
| Credential | PA-C |
| Practice Address |
9495 Sw Locust St Suite A & E Portland OR 97223-6683 |
| Mailing Address |
9495swlocust St A Portland OR 97223-6683 |
| Practice Telephone | 5035055937 |
| Practice Fax Number | 5035055922 |
| Mailing Telephone | 5036369011 |
| Mailing Fax Number | 5036363952 |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2015-08-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500643737 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801452693 | Tara Sharie Pemberton | Nurse Practitioner | 3605 Northgate Ct Ste 110, New Albany, IN 47150-6400 | 2019-05-16 |
| Street Address |
9495 SW LOCUST ST SUITE A & E |
| City | PORTLAND |
| State | OR |
| Zip Code | 97223-6683 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578681896 | Elizabeth Kay Smith | Nurse Practitioner | 9495 Sw Locust St, Suite A, Portland, OR 97223-6683 | 2007-03-26 |
| 1396014114 | Jannelle Marie Fukuji | Physician Assistant | 9495 Sw Locust St, Suite A, Portland, OR 97223-6683 | 2011-12-22 |
| 1598954976 | Timothy Scott Carrasco | Specialist | 9495 Sw Locust St, Suite # A, Portland, OR 97223-6683 | 2007-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760042618 | Tess Ivie Manso | Counselor | 8915 Degrees Center St, Tigard, OR 97223 | 2019-06-13 |
| 1780141804 | Amybrunermd LLC | Obstetrics & Gynecology | 6958 Sw Varns Street, Portland, OR 97223 | 2019-02-25 |
| 1417425034 | Patience Marie Rutto | Counselor | 8915 Sw Center Streret, Tigard, OR 97223 | 2018-11-13 |
| 1871089581 | Marina E Menegol | Behavioral Analyst | Center for Social Dynamics, 9115 Southwest Oleson Rd. Ste. 100, Portland, OR 97223 | 2018-07-05 |
| 1215423165 | Katherine Virginia Eichner | Psychologist | 9860 Sw Hall Blvd Ste B, Tigard, OR 97223 | 2018-07-03 |
| 1043717390 | Rayna Donnelly | Physician Assistant | 9735 Sw Shady Ln Ste 102, Tigard, OR 97223 | 2018-04-11 |
| 1376059725 | Kaylie Marilyn Reyes | Behavioral Analyst | 9115 Sw Oleson Road, Portland, OR 97223 | 2017-12-21 |
| 1841704004 | Kathleen Terrell Taylor | Occupational Therapist | 7320 Sw Hunziker, Suite 203, Tigard, OR 97223 | 2017-11-27 |
| 1487163036 | Susie Riess | Counselor | 10763 Sw Greenburg Road, Suite 100, Tigard, OR 97223 | 2017-09-27 |
| 1043731243 | Tam Nguyen | Optometrist | 8795 Sw Scholls Ferry Rd Ste 100, Tigard, OR 97223 | 2017-06-28 |
| Find all providers in zip 97223 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073081428 | Ishah Marie Price | Physician Assistant | 30 Preble St Apt 663, Portland, ME 04101-4939 | 2018-11-04 |
| 1740797166 | Joseph Something | Physician Assistant | 4800 Sw 76th Ave, Portland, OR 97225-1804 | 2018-01-08 |
| 1235687013 | Satchel Harry | Physician Assistant | 417 Sw 117th Ave Fl 2, Portland, OR 97225-5924 | 2016-09-21 |
| 1922551910 | Ashley Crowell | Physician Assistant | 949 Nw Overton St Unit 306, Portland, OR 97209 | 2016-07-26 |
| 1871982975 | Colin Storz | Physician Assistant | 3623 N Borthwick Ave, Portland, OR 97227-1218 | 2015-01-13 |
| 1275888729 | Stephanie Calvin | Physician Assistant | 782 College St, Portland, TN 37148-2120 | 2012-07-20 |
| 1174800031 | Carolyn Frances Farrell | Physician Assistant | 450 N Graham St, Portland, OR 97227-1682 | 2011-11-07 |
| 1316130198 | Ronald W Kessler | Physician Assistant | 632 Brighton Ave, Portland, ME 04102-1017 | 2007-08-24 |
| 1124210778 | Honey E.l. Marques | Physician Assistant | 16279 Se Division St, Portland, OR 97236-1971 | 2007-08-16 |
| 1124177902 | Dmitriy Shore | Physician Assistant | 10305 Sw Park Way Ste 300, Portland, OR 97225-5033 | 2007-01-09 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.