Healthcare Provider Details

I. General information

NPI: 1124427950
Provider Name (Legal Business Name): MELISSA JEAN KIDBY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12999 S MACDONALDS PL
OREGON CITY OR
97045-7529
US

IV. Provider business mailing address

PO BOX 159
WARRENTON OR
97146-0159
US

V. Phone/Fax

Practice location:
  • Phone: 541-295-5172
  • Fax: 971-362-4818
Mailing address:
  • Phone: 971-368-1980
  • Fax: 541-550-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201800978NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201404684RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: