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General NPI Number Information
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NPI Number | 1578531646
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Entity Type | Individual
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Provider Name | JANICE J KELLY ANP
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Gender | Female
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 1130 NW 22ND AVE, STE 640
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City | PORTLAND
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State | OR
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Zip | 97210-2993
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Country | US
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Telephone | 503-229-7976
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Fax | 503-274-4867
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Provider Business Mailing Address
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Address Line | 1130 NW 22ND AVE, STE 640
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City | PORTLAND
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State | OR
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Zip | 97210-2993
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Country | US
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Telephone | 503-229-7976
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Fax | 503-274-4867
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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 | APRN-3153
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License Number State | HI
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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 | AP30002264
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 000032737N3
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License Number State | OR
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