Clark, Kylie

Clark, Kylie is an individual health care provider with primary practice located at 5050 Ne Hoyt St Suite B55, Portland OR 97213-2991. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Clark, Kylie can be contacted via phone (503) 233-5393.

Contact Information

Primary practice address
5050 Ne Hoyt St Suite B55 Portland OR 97213-2991
Phone: (503) 233-5393
Fax: (503) 659-8984
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD168562 Oregon
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X 2011018538 Missouri

Profile Details

NPI number 1861788101
LBN Legal business name Clark, Kylie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 24th, 2011
Last updated Dec 22nd, 2014 - about 12 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 1861788101 NPPES
Oregon MEDICAID 500674850

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