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General NPI Number Information
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NPI Number | 1285884114
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Entity Type | Individual
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Provider Name | HEIDI JO KELBAR PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 831 NW COUNCIL DR STE 145
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City | GRESHAM
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State | OR
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Zip | 97030-3795
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Country | US
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Telephone | 503-489-2650
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Fax | 503-489-2659
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Provider Business Mailing Address
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Address Line | 7650 SW BEVELAND RD STE 200
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City | PORTLAND
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State | OR
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Zip | 97223-8692
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Country | US
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Telephone | 503-601-3615
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Fax | 503-840-3299
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA164192
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License Number State | OR
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