Individual
KELLY DAVIS ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 418-5150
Mailing address
3181 SW SAM JACKSON PARK RD, OHSU MAILCODE DC 10N, PORTLAND, OR 97239-3011
(503) 418-5168
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
099007722N1
OR
363LF0000X
Family Nurse Practitioner
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022565
—
OR
Enumeration date
08/01/2006
Last updated
08/14/2007
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