Individual
KELLY DALE CARRIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 NW 23RD AVE, PORTLAND, OR 97210-2906
(503) 413-6892
Mailing address
230 MCKENZIE PL, HARRISBURG, OR 97446-9570
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO198390
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/18/2017
Last updated
08/13/2021
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