Individual
KAYLEEN MARIE WELBOURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 214-5200
(503) 906-6613
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA01313
OR
363AS0400X
Surgical Physician Assistant
Primary
PA01313
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1057309
—
WA
05
—
500604994
—
OR
Enumeration date
12/14/2007
Last updated
09/18/2024
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