Individual
IMELDA C KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1350 NE 122ND AVE STE 200, PORTLAND, OR 97230-2011
(503) 408-7008
(503) 408-7045
Mailing address
1350 NE 122ND AVE STE 200, PORTLAND, OR 97230-2011
(503) 408-7008
(503) 408-7045
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD23862
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286671
—
OR
Enumeration date
04/19/2006
Last updated
03/05/2025
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