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General NPI Number Information
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NPI Number | 1184914608
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Entity Type | Individual
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Provider Name | KIMBERLY CAROL FEY POWERS PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 4823 MEADOWS RD STE 127
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-2622
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Country | US
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Telephone | 888-227-3312
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3158
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City | PORTLAND
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State | OR
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Zip | 97208-3158
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Country | US
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Telephone |
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 153-752
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA153752
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License Number State | OR
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