# KELLY WASHBURN, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003560517
- **Authorized official:** ELIZABETH PONDOLFINO (MEDICAL OFFICE MANAGER)
- **Authorized official phone:** (971) 328-0083

## Contact information

- **Practice address:** 5935 SE BELMONT ST, PORTLAND, OR 97215-1925
- **Practice address phone:** (541) 638-0261
- **Practice address fax:** (833) 520-1522
- **Mailing address:** 5935 SE BELMONT ST, PORTLAND, OR 97215-1925
- **Mailing address phone:** (541) 638-0261
- **Mailing address fax:** (833) 520-1522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/04/2022
- **Last updated:** 02/04/2022