KELLEY S. FELLMAN (NPI# 1568484103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568484103 |
| Entity Type | Individual |
| Full Name | KELLEY S. FELLMAN |
| Credential | MD |
| Practice Address |
3415 Se Powell Blvd Portland OR 97202-3371 |
| Mailing Address |
6115 Ne 30th Ave Portland OR 97211-6735 |
| Practice Telephone | 5032349591 |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2009-03-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
MD25861 | OR | Allopathic & Osteopathic Physicians |
| Street Address |
3415 SE POWELL BLVD |
| City | PORTLAND |
| State | OR |
| Zip Code | 97202-3371 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639778715 | Nathanial Bridger Caldwell | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3396 | 2020-10-20 |
| 1104425537 | Jordan Stead | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2020-10-16 |
| 1790383560 | Patricia Sullivan | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2020-10-14 |
| 1336747104 | Kevin Xiong | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2020-10-14 |
| 1609474378 | Gabriella Francolla | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2020-10-14 |
| 1447858121 | Caitlynn Smith | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2020-10-14 |
| 1689281321 | Ava Menchu | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2020-09-27 |
| 1255948014 | Garrett Key | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2020-09-25 |
| 1578170676 | Tenzin Namdol | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2020-09-23 |
| 1740896000 | Nigel Stanford | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2020-09-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073143442 | Carewell LLC | Counselor | Portland River Park Center, 205 Se Spokane St Suite 358, Portland, OR 97202 | 2020-01-24 |
| 1588226765 | Melissa Lynn Hartley | Counselor | 1235 Se Division St. Suite 103, Portland, OR 97202 | 2019-07-08 |
| 1275192999 | Kimberly Rae Kilgore | Counselor | 5509 Se 22nd St #3a, Portland, OR 97202 | 2019-06-06 |
| 1639736069 | Kyra Steinhauer | Social Worker | 3145 Se Powell Blvd, Portland, OR 97202 | 2019-05-21 |
| 1134644321 | Bridgette Hennigsen | Social Worker | 3810 Se 11th Ave, Portland, OR 97202 | 2017-08-08 |
| 1558895789 | Lenore Cangeloso | Acupuncturist | 1235 Se Division Street, Suie 117, Portland, OR 97202 | 2017-04-14 |
| 1376099093 | Anna Christine Leclerc | Contractor | 2024 Se Clinton Street, Zenana Spa and Wellness Center, Portland, OR 97202 | 2016-09-01 |
| 1144684663 | Catholic Charities | Case Management | 2740 Se Powell Blvd., Portland, OR 97202 | 2016-04-11 |
| 1881082097 | Zoomcare Dental, P.C. | Dentist | 3130 Se Division Street, Building 2, Portland, OR 97202 | 2014-12-23 |
| 1124424700 | Jessica Nash | Counselor | 6411 Se 17th Ave, Portland, OR 97202 | 2014-11-10 |
| Find all providers in zip 97202 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831455211 | Nicholas Austin | Psychiatry & Neurology | 3181 Sw Sam Jackson Park Rd Dept Of, Portland, OR 97239-3011 | 2012-04-10 |
| 1235446303 | Ervin Gene Stubbs | Psychiatry & Neurology | 7032 Sw 3rd Ave, Portland, OR 97219-2214 | 2010-09-09 |
| 1851525620 | Sarah Morgan Schrauben | Psychiatry & Neurology | 870 Se 82nd Ave., Portland, OR 97027 | 2009-05-08 |
| 1700077328 | Hanh Ngoc Nguyen | Psychiatry & Neurology | 5410 Sw Macadam Ave Ste 200, Portland, OR 97239 | 2007-08-08 |
| 1912116013 | John Barrows Chenoweth | Psychiatry & Neurology | 5410 S.w. Macadam Ave, Ste 200, Portland, OR 97239-3825 | 2007-05-22 |
| 1043340219 | Birgit Meyer | Psychiatry & Neurology | 3415 Se Powell Blvd., Portland, OR 97202 | 2007-03-06 |
| 1518029768 | Barbara Jean Baker | Psychiatry & Neurology | 1818 Se Division St, Portland, OR 97202-1159 | 2006-12-14 |
| 1790851574 | Dena K Drasin | Psychiatry & Neurology | 6834 Se 28th Ave, Portland, OR 97202-8705 | 2006-11-25 |
| 1700966926 | Jonathan Joseph Valen | Psychiatry & Neurology | 506 Sw 6th Ave, Ste 602, Portland, OR 97204-1533 | 2006-10-16 |
| 1275628380 | Kenneth David Holladay | Psychiatry & Neurology | 9830 Ne Cascades Pkwy, Suite 200, Portland, OR 97220-6832 | 2006-10-04 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.