Provider Demographics
NPI:1396020251
Name:PRILL, KELLY (ND)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:PRILL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 N WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5252
Mailing Address - Country:US
Mailing Address - Phone:503-407-1238
Mailing Address - Fax:
Practice Address - Street 1:200 NE 20TH AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3094
Practice Address - Country:US
Practice Address - Phone:971-270-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1853175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath