Healthcare Provider Details

I. General information

NPI: 1134660558
Provider Name (Legal Business Name): KELCEY CHILCOTT PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 05/19/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E MAIN ST
HILLSBORO OR
97123-4084
US

IV. Provider business mailing address

455 E MAIN ST.
HILLSBORO OR
97123
US

V. Phone/Fax

Practice location:
  • Phone: 503-640-2757
  • Fax:
Mailing address:
  • Phone: 503-640-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number201701617NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: