MRS. STACY L. HARTLINE (NPI# 1568661528) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568661528 |
| Entity Type | Individual |
| Full Name | MRS. STACY L. HARTLINE |
| Credential | APRN, PMHNP |
| Practice Address |
912 Ne Kelly Ave, Suite 200 Gresham OR 97030 |
| Mailing Address |
912 Ne Kelly Ave. Suite 200 Gresham OR 97030 |
| Practice Telephone | 5032584600 |
| Practice Fax Number | 5036672580 |
| Mailing Telephone | 5032584600 |
| Mailing Fax Number | 5034132649 |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2014-11-05 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
200750069NP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 163WP0807X |
Registered Nurse Specialization: Psych/Mental Health, Child & Adolescent |
200542250RN | OR | Nursing Service Providers |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
20075006NPTMHNP- | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
912 NE KELLY AVE, SUITE 200 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 163WP0807X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health, Child & Adolescent |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164895173 | Jessica L Newgard | Registered Nurse | 9135 Sw Barnes Rd Ste 761, Portland, OR 97225-6777 | 2015-11-12 |
| 1295128650 | Marla Castello | Registered Nurse | 2828 Sw Kelly Ave Ste B, Portland, OR 97201-4809 | 2015-03-10 |
| 1972928034 | Jennifer Joe-anne Marks | Registered Nurse | 312 Oak St. Ste #205, Central Point, OR 97502 | 2014-02-26 |
| 1376883488 | Jennifer Dyann Tucker | Registered Nurse | 2650 Nw Princess St, Corvallis, OR 97330-3219 | 2013-02-26 |
| 1124378526 | Melissa Hess | Registered Nurse | 3415 Se Powell Blvd # 97202, Portland, OR 97202-3371 | 2012-09-12 |
| 1396051637 | Justin Nicholas Bethoney | Registered Nurse | 151 Sw Shevlin Hixon Dr Ste 102, Bend, OR 97702-3232 | 2010-08-24 |
| 1770705527 | Carol B. Mason | Registered Nurse | 722 Ne 162nd Avenue, Portland, OR 97230 | 2007-05-02 |
| 1346325883 | Cynthia Kathleen Rutto | Registered Nurse | 2929 Sw Multnomah Blvd Ste 102, Portland, OR 97219-4070 | 2006-10-25 |
| 1447862198 | Kiana Wood | Registered Nurse | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2020-08-22 |
| 1134737521 | Tia Nadler | Registered Nurse | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2020-07-21 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MRS. STACY L. HARTLINE.
| 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.