Russell, Kimberly Ann
Russell, Kimberly Ann is an sole proprietor health care provider with primary practice located at 617 Ne Davis St , Mcminnville OR 97128-4716. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Behavioral Health & Social Service Providers / Social Worker. Other Service Providers / Case Manager/Care Coordinator is her primary health care specialty. Russell, Kimberly Ann can be contacted via phone (503) 472-4020.Contact Information
Primary practice address
617 Ne Davis St
Mcminnville OR 97128-4716
Phone: (503) 472-4020
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Case Manager/Care Coordinator | 171M00000X | ||
| Behavioral Health & Social Service Providers / Social Worker | 104100000X |
Profile Details
| NPI number | 1003939943 |
|---|---|
| LBN Legal business name | Russell, Kimberly Ann |
| Credentials | B.S |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 7th, 2007 |
| Last updated | Dec 3rd, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003939943 | NPPES |
| Oregon | MEDICAID | 50067381 |
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