Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

MS. Mallory Johnson, PEDIATRICNP

Individual provider Pediatric Nurse Practitioner · NPI 1265699508

MS. Mallory Johnson, PEDIATRICNP is a Pediatric Nurse Practitioner in Portland, Oregon. Practices as a sole proprietor. Licensed in Oregon.

Licensed in
OR
In the registry since
2008

Practice location Address checks out

11790 SW Barnes Rd Blg A Ste 140
Portland, OR 97225
Phone: (503) 643-2100
Fax: (503) 643-7300
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Nurse Practitioner (primary) Taxonomy 363LP0200X · Licence 200850163NP (OR)

Record details

NPI number1265699508
Entity typeIndividual (Type 1)
GenderFemale
Credentials PEDIATRICNP
Sole proprietorYes
NPI enumeratedMay 22, 2008
Last updated in NPPESOctober 18, 2021
Certification dateOctober 18, 2021

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