Anderson, Kelly Davis

Anderson, Kelly Davis is an individual health care provider with primary practice located at 3181 Sw Sam Jackson Park Rd , Portland OR 97239-3011. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Anderson, Kelly Davis can be contacted via phone (503) 418-5150.

Contact Information

Primary practice address
3181 Sw Sam Jackson Park Rd Portland OR 97239-3011
Phone: (503) 418-5150
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 099007722N1 Oregon
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X Oregon

Profile Details

NPI number 1730195330
LBN Legal business name Anderson, Kelly Davis
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 1st, 2006
Last updated Aug 14th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730195330 NPPES
Oregon MEDICAID 022565

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