Healthcare Provider Details

I. General information

NPI: 1396020186
Provider Name (Legal Business Name): KIMBERLEE ANN FIELDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 SW 105TH AVE STE 206
BEAVERTON OR
97008-5487
US

IV. Provider business mailing address

6800 SW 105TH AVE STE 206
BEAVERTON OR
97008-5487
US

V. Phone/Fax

Practice location:
  • Phone: 503-430-1777
  • Fax: 503-430-1777
Mailing address:
  • Phone: 503-430-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA160106
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: