1639144181 NPI number — MS. KIMBERLY BIGGS SANDERS PHYSICIAN ASSISTANT

Table of content: MS. KIMBERLY BIGGS SANDERS PHYSICIAN ASSISTANT (NPI 1639144181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639144181 NPI number — MS. KIMBERLY BIGGS SANDERS PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
KIMBERLY
Provider Middle Name:
BIGGS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BIGGS
Provider Other First Name:
KIM
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639144181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3303 SW BOND AVE
Provider Second Line Business Mailing Address:
CH16D
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97239-4501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-418-3376
Provider Business Mailing Address Fax Number:
503-494-6968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3303 SW BOND AVE
Provider Second Line Business Practice Location Address:
CH16D
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-418-3376
Provider Business Practice Location Address Fax Number:
503-494-6968
Provider Enumeration Date:
02/20/2006

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:  PA10004982 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA01062 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PA01062 . This is a "PHYSICIAN ASSITANT" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: PA10004982 . This is a "STATE OF WASHINGTON" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3265 . This is a "LIMITED PERMIT" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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