Healthcare Provider Details

I. General information

NPI: 1225103831
Provider Name (Legal Business Name): KERRIE LYNN ADAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 SW 65TH AVE STE 325
TUALATIN OR
97062-7452
US

IV. Provider business mailing address

7650 SW BEVELAND RD STE 200
PORTLAND OR
97223-8692
US

V. Phone/Fax

Practice location:
  • Phone: 503-855-1600
  • Fax: 503-855-1609
Mailing address:
  • Phone: 503-601-3615
  • Fax: 503-646-1683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD206682
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD206682
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: