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General NPI Number Information
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NPI Number | 1457605958
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Entity Type | Individual
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Provider Name | KELLY WASHBURN MSN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 10/16/2021
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Provider Practice Location Address
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Address Line | 5935 SE BELMONT ST
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City | PORTLAND
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State | OR
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Zip | 97215-1925
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Country | US
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Telephone | 860-670-6348
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Fax |
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Provider Business Mailing Address
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Address Line | 5935 SE BELMONT ST
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City | PORTLAND
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State | OR
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Zip | 97215-1925
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Country | US
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Telephone | 971-328-0083
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Fax | 833-502-1522
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5118
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201503413NP-PP
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License Number State | OR
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