Healthcare Provider Details

I. General information

NPI: 1457742181
Provider Name (Legal Business Name): KALEN WALKINGTON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 NE COUCH ST.
PORTLAND OR
97232
US

IV. Provider business mailing address

1027 E. BURNSIDE ST.
PORTLAND OR
97214
US

V. Phone/Fax

Practice location:
  • Phone: 503-239-8400
  • Fax: 503-239-8407
Mailing address:
  • Phone: 503-239-8400
  • Fax: 503-269-8407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number201407031RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: