Individual
MRS. SERENA PHROMSIVARAK KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACPNP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, MAIL CODE DC8N, PORTLAND, OR 97239-3011
(503) 418-5881
Mailing address
3181 SW SAM JACKSON PARK RD, MAIL CODE: DC8N, PORTLAND, OR 97239-3011
(503) 418-5881
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
200750101
OR
Other
Enumeration date
08/29/2007
Last updated
11/16/2016
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