KIM MICHELLE KELLY


Address: 12710 Se Division Street, Portland, OR 97236
Phone: 5039883601

KIM MICHELLE KELLY (NPI# 1578585501) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1578585501
Entity Type Individual
Full Name KIM MICHELLE KELLY
Credential M.D.
Practice Address 12710 Se Division Street
Portland
OR 97236
Mailing Address 421 Sw Oak St.
#210
Portland
OR 97204
Practice Telephone 5039883601
Mailing Telephone 5039883663
Mailing Fax Number 5039884098
Enumeration Date 2006-07-25
Last Update Date 2010-03-08
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207Q00000X Family Medicine 47017 MN Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
MN DEA # BK7429930 01

Other Providers KIM KELLY

NPI Name Taxonomy Address Enumeration
1992198584 Kim Marie Kelly Behavioral Analyst 20 Tater St, Mont Vernon, NH 03057-1315 2015-03-06
1851630412 Kim A Kelly Counselor 2528 Oak St, Jacksonville, FL 32204-4504 2013-02-01
1689950800 Kim C Kelly Speech-Language Pathologist 678 Cantiague Rock Rd, Jericho, NY 11753-1401 2011-11-02
1538302799 Kim Darrell Kelly Naturopath 1363 Burgundy Rd, Encinitas, CA 92024-1847 2009-04-16
1740380633 Kim Erin Kelly Counselor 333 S Juniper St, #115, Escondido, CA 92025-4924 2006-09-22
1790119857 Kim Marie Kelly Pharmacist 1401 Bombing Range Rd, West Richland, WA 99353-8001 2013-08-26
1730457193 Kim J Kelly Counselor 200 S Pollock St, Selma, NC 27576-3062 2011-12-13
1457453326 Kim H Kelly Registered Nurse 111 S Front St, Harrisburg, PA 17101-2010 2006-09-02

Office Location

Street Address 12710 SE DIVISION STREET
City PORTLAND
State OR
Zip Code 97236

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1336650357 Wondmimu Edao Chako Registered Nurse 3708 Se 144th Avenue, Portland, OR 97236 2017-10-17
1881142388 John Ho Pharmacist 14700 Se Division St., Portland, OR 97236 2016-09-14
1306392527 Lori-ann Lima Nurse Practitioner Multnomah County Health Department- Mid Cty Health Ctr, 12710 Se Division St, Portland, OR 97236 2016-08-28
1982096202 Allan Fitzpatrick Beals-gibson Adult Companion 15602 Se Division St., Portland, OR 97236 2015-02-24
1386047132 Columbiacare Services Community Based Residential Treatment Facility, Mental Illness 3530 Se 136th Ave. #5, Portland, OR 97236 2014-10-07
1356750319 Kendra Harding Counselor 17214 Se Division Street, Portland, OR 97236 2014-08-04
1659790400 Nghia Tran Pharmacist 8438 Se 138th Dr, Portland, OR 97236 2014-04-09
1942623764 Laurel Katherine Hallock Koppelman Nurse Practitioner 12720 Se Division Street, Portland, OR 97236 2014-01-30
1982046249 Victoria D Lathrop Massage Therapist 17221 Se Divistion St S-21, Portland, OR 97236 2013-07-26
1669819694 Ariann Von Vaughn Dental Hygienist 18011 Se Pershing Ct, Portland, OR 97236 2013-05-31
Find all providers in zip 97236

Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1639710783 Christine Elizabeth O'connor Family Medicine 6336 Se 61st Ave, Portland, OR 97206-6718 2019-09-30
1427608645 Carehere LLC Family Medicine Carehere Clinic- Nasg Portland, Tn, 160 Kirby Drive, Portland, TN 37148 2019-09-19
1063064285 Victoria A Deane Family Medicine 37 Fall Brook St, Portland, ME 04103-4224 2019-07-09
1598238214 Whole Systems Healthcare Family Medicine 1020 Sw Taylor St Ste 340, Portland, OR 97205-2508 2019-01-04
1770089245 Richard Farwell Leman Family Medicine 800 Ne Oregon St., Suite 772, Portland, OR 97232 2018-04-03
1952803413 Aleksandra Giedowyn Md PC Family Medicine 1923 Ne Broadway Street Suite 2, Portland, OR 97232 2018-03-01
1871943159 Micah Kiehl Family Medicine 4427 Ne Fremont St, Portland, OR 97213-1153 2016-06-16
1083068589 Carrie Lynn Binder Family Medicine 1035 Nw Northrup St, Portland, OR 97209-3017 2016-04-20
1437513835 Kayce A Spear Family Medicine 10803 Se Cherry Blossom Drive, Portland, OR 97216-3107 2016-04-12
1992175509 Lone Star Evaluations Inc. Family Medicine 1500 Wildcat Dr Ste M, Portland, TX 78374-2826 2015-09-25
Find all providers in PORTLAND

Competitor

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City PORTLAND
Zip Code 97236

Improve Information

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Dataset Information

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.

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