Provider Demographics
NPI:1295239168
Name:EMCH, ANNEMIEKE CLARK (PMHNP)
Entity type:Individual
Prefix:
First Name:ANNEMIEKE
Middle Name:CLARK
Last Name:EMCH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ANNEMIEKE
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 NW BETHANY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5236
Mailing Address - Country:US
Mailing Address - Phone:503-741-2735
Mailing Address - Fax:503-308-7222
Practice Address - Street 1:1500 NW BETHANY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5236
Practice Address - Country:US
Practice Address - Phone:503-741-2735
Practice Address - Fax:503-308-7222
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60866557363LP0808X
OR201805147NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health