1972548865 NPI number — MS. KIMBERLY KAY FELDER PA-C

Table of content: MS. KIMBERLY KAY FELDER PA-C (NPI 1972548865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972548865 NPI number — MS. KIMBERLY KAY FELDER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELDER
Provider First Name:
KIMBERLY
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SILVERNAIL
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972548865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3181 SW SAM JACKSON PARK RD. L457
Provider Second Line Business Mailing Address:
OREGON HEALTH SCIENCE UNIVERSITY
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-494-9444
Provider Business Mailing Address Fax Number:
503-494-4264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3181 SW SAM JACKSON PARK RD. L457
Provider Second Line Business Practice Location Address:
OREGON HEALTH SCIENCE UNIVERSITY
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-494-9444
Provider Business Practice Location Address Fax Number:
503-494-4264
Provider Enumeration Date:
06/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA00804 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: PA00804 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: ORPA00804 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104711 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: ORPA00804 . This is a "OREGON BOARD OF MEDICAL EXAMINERS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".