| Visionary Psychiatry | |
|
535 Se Washington St Hillsboro OR 97123-4142 | |
| (503) 755-6703 | |
| (503) 755-6704 |
| Full Name | Visionary Psychiatry |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 535 Se Washington St, Hillsboro, Oregon |
| Authorized Official Name and Position | Carmen L Kosicek (OWNER, PROVIDER) |
| Authorized Official Contact | 5037556703 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Visionary Psychiatry 7426 N La Cholla Blvd Tucson AZ 85741-2306 Ph: (503) 755-6703 | Visionary Psychiatry 535 Se Washington St Hillsboro OR 97123-4142 Ph: (503) 755-6703 |
| NPI Number | 1952860066 |
|---|---|
| Provider Enumeration Date | 03/18/2019 |
| Last Update Date | 10/10/2024 |
| Certification Date | 10/10/2024 |
| Medicare PECOS PAC ID | 9032537329 |
|---|---|
| Medicare Enrollment ID | O20200918000789 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952860066 | NPI | - | NPPES |
| Provider Name | Carmen Kosicek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255863767 PECOS PAC ID: 3375800857 Enrollment ID: I20200918000878 |
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