Healthcare Provider Details

I. General information

NPI: 1801443221
Provider Name (Legal Business Name): KINDA LILLEY-KARKOS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KINDA LILLEY

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E POWELL BLVD
GRESHAM OR
97080-1365
US

IV. Provider business mailing address

18693 SW BLANTON ST
ALOHA OR
97078-1285
US

V. Phone/Fax

Practice location:
  • Phone: 503-669-4300
  • Fax: 503-669-4301
Mailing address:
  • Phone: 207-491-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: