Provider Demographics
NPI:1366812372
Name:CHIPMAN, TYLER CLARK (PMHNP)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:CLARK
Last Name:CHIPMAN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2942 SE YAMHILL ST APT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4092
Mailing Address - Country:US
Mailing Address - Phone:503-593-9521
Mailing Address - Fax:
Practice Address - Street 1:600 NE 8TH ST STE 300
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7318
Practice Address - Country:US
Practice Address - Phone:503-988-5155
Practice Address - Fax:503-988-5185
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201506224NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health