Individual
LORI H KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3303 SW BOND AVE, PORTLAND, OR 97239-4501
(503) 494-4373
Mailing address
3181 SW SAM JACKSON PARK RD, GH 219, PORTLAND, OR 97239-3011
(503) 494-1484
(503) 494-1409
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00942
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500602706
—
OR
05
—
8502619
—
WA
Enumeration date
06/27/2005
Last updated
08/23/2010
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