Individual
MRS. KELLY MARIE KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
13013 SW CADDY PL, TIGARD, OR 97223-2892
(503) 766-3263
Mailing address
13013 SW CADDY PL, TIGARD, OR 97223-2892
(503) 766-3263
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
LL17410
OR
Other
Enumeration date
10/09/2007
Last updated
10/14/2020
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