Healthcare Provider Details

I. General information

NPI: 1477799500
Provider Name (Legal Business Name): KRISTIN KIMMEL SCHMIDTGALL MPH, MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN KIMMEL DUNLAP MPH, MPAS, PA-C

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3207 SW PERKINS AVE
PENDLETON OR
97801-4465
US

IV. Provider business mailing address

3207 SW PERKINS AVE
PENDLETON OR
97801-4465
US

V. Phone/Fax

Practice location:
  • Phone: 541-215-1564
  • Fax: 541-215-1567
Mailing address:
  • Phone: 541-276-4642
  • Fax: 541-276-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number150100
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: