Provider Demographics
NPI:1598190274
Name:UNDERHILL, KENDRA M (PA)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:M
Last Name:UNDERHILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6924 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5256
Mailing Address - Country:US
Mailing Address - Phone:503-300-4111
Mailing Address - Fax:503-954-2122
Practice Address - Street 1:6924 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5256
Practice Address - Country:US
Practice Address - Phone:503-300-4111
Practice Address - Fax:503-954-2122
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR164985363AM0700X
ORMD1738222086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical