Kelly, Jennifer Suzanne

Kelly, Jennifer Suzanne is an individual health care provider with primary practice located at 19250 Sw 65Th Ave Ste 300, Tualatin OR 97062-7452. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Kelly, Jennifer Suzanne can be contacted via phone (503) 692-1242.

Contact Information

Primary practice address
19250 Sw 65Th Ave Ste 300 Tualatin OR 97062-7452
Phone: (503) 692-1242
Fax: (503) 691-3615
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X MD 27685 Oregon

Profile Details

NPI number 1881802627
LBN Legal business name Kelly, Jennifer Suzanne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2007
Last updated Jun 18th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881802627 NPPES
Oregon Other R157973 MEDICARE PTAN
Oregon MEDICAID 500623446 MEDICARE PTAN

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