Basic Information
| Provider Information | |||||||||
| NPI: | 1427065234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEDGES | ||||||||
| FirstName: | SHERYL | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | NP,PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 SW OAK ST. | ||||||||
| Address2: | 210 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039883663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12710 SE DIVISION ST. | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039883601 | ||||||||
| FaxNumber: | 5039884098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 02/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 090007034N6 | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LC1500X | 090007034N6 | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health | 363LP0808X | 090007034N6 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 292317 | 05 | OR | MEDICAID |