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NPI Code Detail

MEDICARE: MS. KIMBERLY ANNE BRANDT NP

MEDICARE: MS. KIMBERLY ANNE BRANDT NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner200150075NPOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1200150075NPOTHERORLIC #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851304281
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY ANNE BRANDT NP
Provider Business Mailing Address
First Line : 10362 SW MCDONALD ST
Second Line :
City : TIGARD
State : OR
Zip : 97224-4863
Country : US
Telephone Number : 503-624-0312
Fax Number : 503-639-3973
Provider Business Practice Location Address
First Line : 10362 SW MCDONALD ST
Second Line :
City : TIGARD
State : OR
Zip : 97224-4863
Country : US
Telephone Number : 503-624-0312
Fax Number : 503-639-3973
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 03/07/2023

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