Healthcare Provider Details

I. General information

NPI: 1467512277
Provider Name (Legal Business Name): KIMBERLY E KINTZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 COTTAGE ST SE
SALEM OR
97301-3808
US

IV. Provider business mailing address

7191 RIVER BEND DR NE
SILVERTON OR
97381-9149
US

V. Phone/Fax

Practice location:
  • Phone: 503-364-2427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number087000274N3
License Number StateOR

VIII. Authorized Official

Name: MRS. KIMBERLY E KINTZ
Title or Position: MD
Credential: ANP
Phone: 503-364-2427