Provider Demographics
NPI:1700211513
Name:CARTER, JILL ANN (DNP, PMHNP, FNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:CARTER
Suffix:
Gender:F
Credentials:DNP, PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SE LAKE RD STE 135
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2189
Mailing Address - Country:US
Mailing Address - Phone:888-830-6088
Mailing Address - Fax:888-850-5616
Practice Address - Street 1:6400 SE LAKE RD STE 135
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-2189
Practice Address - Country:US
Practice Address - Phone:971-430-2335
Practice Address - Fax:888-850-5616
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00129629163W00000X
OR201392160NP-PP363LP0808X, 363LF0000X
WAAP60411729363LF0000X
OR096000794RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily