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General NPI Number Information
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NPI Number | 1124427950
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Entity Type | Individual
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Provider Name | MELISSA JEAN KIDBY NP
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Gender | Female
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 12999 S MACDONALDS PL
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City | OREGON CITY
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State | OR
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Zip | 97045-7529
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Country | US
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Telephone | 541-295-5172
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Fax | 971-362-4818
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Provider Business Mailing Address
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Address Line | PO BOX 159
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City | WARRENTON
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State | OR
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Zip | 97146-0159
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Country | US
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Telephone | 971-368-1980
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Fax | 541-550-2908
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 201800978NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 201404684RN
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License Number State | OR
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