Provider Demographics
NPI:1134274400
Name:KOONCE, CHRISTINE MARIE (PMHNP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:KOONCE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:3715 N LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1021
Mailing Address - Country:US
Mailing Address - Phone:503-284-1031
Mailing Address - Fax:503-215-7864
Practice Address - Street 1:13007 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2545
Practice Address - Country:US
Practice Address - Phone:503-215-0063
Practice Address - Fax:503-215-7864
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080045311RN163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health