Provider Demographics
NPI:1215193057
Name:NERSASIAN, KELEIGH MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KELEIGH
Middle Name:MARIE
Last Name:NERSASIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6370 SW BORLAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9768
Mailing Address - Country:US
Mailing Address - Phone:503-691-1122
Mailing Address - Fax:503-691-1144
Practice Address - Street 1:6370 SW BORLAND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9768
Practice Address - Country:US
Practice Address - Phone:503-691-1122
Practice Address - Fax:503-691-1144
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical