Healthcare Provider Details

I. General information

NPI: 1477181592
Provider Name (Legal Business Name): KILEY ANNE PEARL LAWRENCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD SJH-2
PORTLAND OR
97239
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-7641
  • Fax: 503-494-4661
Mailing address:
  • Phone:
  • Fax: 503-346-8021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1020732
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD229009
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: