Individual
KIMBERLY K RODDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
16180 SE SUNNYSIDE RD, SUITE 102, HAPPY VALLEY, OR 97015-6301
(503) 582-4900
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200550088NP FNPPP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278678
—
OR
01
—
P00881768
RR MEDICARE
OR
Enumeration date
09/26/2005
Last updated
10/28/2012
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