Pridgen, Kelly Dean
Pridgen, Kelly Dean is an individual health care provider with primary practice located at 1601 Se Court Ave , Pendleton OR 97801-3217. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Pridgen, Kelly Dean can be contacted via phone (541) 276-5121.Contact Information
Primary practice address
1601 Se Court Ave
Pendleton OR 97801-3217
Phone: (541) 276-5121
Fax: (541) 278-3661
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | MD24109 | Oregon |
Profile Details
| NPI number | 1013955798 |
|---|---|
| LBN Legal business name | Pridgen, Kelly Dean |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 3rd, 2006 |
| Last updated | Mar 5th, 2008 - about 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013955798 | NPPES |
| Oregon | Other | 0224305 | LIWA |
| Oregon | MEDICAID | 181590 | LIWA |
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