Healthcare Provider Details

I. General information

NPI: 1841601846
Provider Name (Legal Business Name): JESSICA LEE SMILEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LEE SANDERS D.O.

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 ULALI DR NE
KEIZER OR
97303-1500
US

IV. Provider business mailing address

500 NE MULTNOMAH ST STE 100
PORTLAND OR
97232-2031
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax:
Mailing address:
  • Phone: 800-813-2000
  • Fax: 855-524-5255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPG168239
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO184102
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: