Provider Demographics
NPI:1073544524
Name:FLESKES, KAY M (FNP)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:M
Last Name:FLESKES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4949
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4949
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:8507 S 5TH ST
Practice Address - Street 2:SUITE 113
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-3421
Practice Address - Country:US
Practice Address - Phone:360-887-9494
Practice Address - Fax:360-887-9498
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR86006483N1163W00000X
WAAP30004336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S69089Medicare UPIN