Healthcare Provider Details

I. General information

NPI: 1053843912
Provider Name (Legal Business Name): KALLI KEDDIE N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 NE HIGHWAY 99W
MCMINNVILLE OR
97128-2712
US

IV. Provider business mailing address

222 MELODY CT
NEWBERG OR
97132-4018
US

V. Phone/Fax

Practice location:
  • Phone: 503-883-0333
  • Fax: 503-857-0622
Mailing address:
  • Phone: 262-501-3410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: