Individual
KELLY DEAN PRIDGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1601 SE COURT AVE, PENDLETON, OR 97801-3217
(541) 276-5121
(541) 278-3661
Mailing address
505 S 336TH ST, SUITE 600, FEDERAL WAY, WA 98003-6328
(253) 838-6180
(253) 838-6418
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD24109
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0224305
LIWA
OR
05
—
181590
—
OR
Enumeration date
06/03/2006
Last updated
03/05/2008
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