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Individual

KELLIE NIGHTINGALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1118 OAK ST SE, SALEM, OR 97301-4019
(503) 585-4949
Mailing address
1118 OAK ST SE, SALEM, OR 97301-4019
(503) 585-4949

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1255964730
OR
05
171M00000X
OR
Enumeration date
03/04/2018
Last updated
09/25/2023
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